Junior Climate Champions

Junior Climate Champions

Please fill in this form to sign up // 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?*

YesNo
Tick to sign up to our mailing list.*

I want to receive emails about our upcoming events.
Parent/Carer Signature*

Clear
Should be Empty: