JAM Registration Form

JAM After School Care Registration
Child's Name*

First NameLast Name
Aultmore ParkOakwoodSt BenedictsOur Lady of PeaceSwintonHoliday Club Only
Birth Date*

DayMonthYear
MondayTuesdayWednesdayThursdayFridayHoliday Care
Please select start date for ASC

MonthDayYear
Date
Parent/Guardian 1
Name*

First NameLast Name
Address*

Postcode
Email*
example@example.com
Work Number *
Mobile *
Parent/Carer 2
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Number
Mobile Number
In order for us to provide the appropriate care for your child while attending JAM, please detail any care needs, medical information, support needs, allergies etc. *
Should be Empty:

Parent/Guardian 1