Green Kids Club

Green Kids Club

Please fill in this form to sign up to Green Kids Club // Tuesdays 4.00-5.30pm // FREE
Name of child

First NameLast Name
Birth Date

MonthDayYear
Gender
Address

Street Address

Street Address Line 2

London Borough

Postcode
What school does your child attend?
Ethnicity
If you would like to add a sibling, please add below: Name of sibling:

First NameLast Name
Gender
Date of birth

MonthDayYear
Date
Parent/Carer Name
Parent/Carer Phone Number
07987998823
Parent/Carer Email
example@example.com
Emergency Contact 1 - this person will only be contacted if we cannot get hold of the parent/carer in an emergency

Name

Phone Number

Relationship to child
Does your child have any medical needs, educational needs or mobility issues?
Does your child have any allergies? In this club we use clay, look at seeds, fruit, plants, leaves etc. Sometimes we try new healthy foods. Please be specific with any allergies. Thank you.
If someone other than the parent/carer is collecting the child, or if your child is going home on their own, please tell us here:
How did you hear about this after school club?
Are you happy for your child to be photographed for future promotion on Grand Junction's website and social media?
Tick to sign up to our mailing list.
Parent/Carer Signature
Should be Empty: