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*

ArabicAsian/ Asian BritishBlack/ Black BritishWhiteMultiple ethnic groupsOtherPrefer not to say
Child's school*
I would like to sign up a sibling: Name

First NameLast Name
Date of Birth
Ethnicity

ArabicAsian/ Asian BritishBlack/ Black BritishWhiteMultiple ethnic groupsOtherPrefer not to say
Child's school
Parent/carer details
Name*

First NameLast Name
Phone Number:*

Phone Number
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?*

FlyerSocial MediaThrough friends/familyOn our websiteOther
Are you happy for your child to be photographed for future promotion on Grand Junction's website and social media?*

YesNo
Do you want you email added to our mailing list?*

YesNo
If someone other than the parent/carer is collecting the child, please tell us their name and relationship to you here:*

I would like my child to be picked up by someone else
Name of adult collecting my child, and relationship to child*
Tick here to confirm your child will attend all of the dates*

My child will attend all sessions.We cannot attend every week
Parent/carer Signature*

Clear
Should be Empty:

Junction Juniors Application Form

Child/participant details

Parent/carer details