Junction Juniors

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 4pm - 5.30pm

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
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?*

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*
This is a free afterschool session as we want as many children to attend as possible. We do, however, ask that families agree to the following so that our sessions run smoothly and that all participants are safe and want to come back!
Please tick below to confirm:*

I confirm that my child will follow instructionsI confirm that my child will arrive on time, and if running late, inform the Grand Junction teamI confirm that my child will behave in a safe, kind and respectful way
Parent/carer Signature*

Clear
Should be Empty:

Junction Juniors Application Form

Child/participant details

Parent/carer details