Junction Juniors Application form

Junction Juniors Application Form
You are signing up to Junction Juniors, a fun-packed after-school club offering a mixture of creative activities for children in Year 3 - Year 6 (age 7-11)

When: Mondays 3.45-5.15pm

All our facilitators are DBS checked and have lots of experience teaching children and young people.

If you have any questions, please contact our Young People and Families Manager - joanne@grandjunction.org.uk
Child/participant details
Name

First NameLast Name
Date of Birth
Ethnicity
Child's school
I would like to sign up a sibling: Name

First NameLast Name
Date of Birth
Child's school
Parent/carer details
Name

First NameLast Name
Parent/ Carer Phone Number
07986543210
E-mail
example@example.com
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact 1: We will only contact this person if we cannot contact the main parent in an emergency.

Name

Number

Relationship to childState / Province

Postal / Zip Code
Emergency Contact 2: We will only contact this person if we cannot contact the main parent in an emergency.

Name

Number

Relationship to childState / Province

Postal / Zip Code
Does your child have any medical or mobility issues? If yes, please give details.
Does your child require any additional support you feel helpful for us to know so we can support your child in the most appropriate way? If yes, please give details.
Where did you hear about us?

Other
Are you happy for your child to be photographed for future promotion on Grand Junction's website and social media?
Do you want you email added to our mailing list?
If someone other than the parent/carer is collecting the child, please tell us their name and relationship to you here:
Name of adult collecting my child, and relationship to child
Tick here to confirm your child will attend all of the dates
Parent/carer Signature
Should be Empty:

Junction Juniors Application Form

Child/participant details

Parent/carer details