Captain Ted’s Afterschool Club Registration

Captain Ted’s Afterschool Club Registration

Thank you for choosing Captain Ted’s Afterschool Club! Please complete all fields below. Fields marked * are mandatory - places will be confirmed upon receipt of payment
Child's Details
Full Name

First NameLast Name
Date of Birth

DayMonthYear
Date
Age on September 1st 2026
Gender
School Attending in September 2026
First Language
Year group
Add additional child
Additional child Full Name

First NameLast Name
Additional child Date of Birth

DayMonthYear
Date
Additional child Age on September 1st 2026
Additional child Gender
Additional child School Attending in September 2026
Additional child First Language
Additional child Year group
Parent's /Guardian's Details 1
Parent/Guardian

First NameLast Name
Relationship
Address

Street Address

Street Address Line 2

CityCounty

Post Code
Work Address

Street Address

Street Address Line 2

CityCounty

Post Code
Mobile Number

Area CodePhone Number
Work Number

Area CodePhone Number
Email
example@example.com
Parent's /Guardian's Details 2
Parent's/ Guardian 2

First NameLast Name
Relationship
Address
Address

Street Address

Street Address Line 2

CityCounty

Post Code
Work Address

Street Address

Street Address Line 2

CityCounty

Post Code
Mobile Number

Area CodePhone Number
Work Number

Area CodePhone Number
Email
example@example.com
Emergency Contact Details

(please provide details of two people we can contact if we are unable to get hold of you)
Contact 1

First NameLast Name
Emergency Contact Mobile Number

Area CodePhone Number
Relationship to Child
Contact 2

First NameLast Name
Emergency Contact Mobile Number

Area CodePhone Number
Relationship to Child
Child's Doctor
Name of Doctor
Doctor's Number

Area CodePhone Number
About Your Child
Please detail any additional/special needs your child has: (please provide full details)
Please detail any dietary requirements / food allergies for your child: (please provide full details
Afterschool Club - Select Session Dates

2 Hour Session £15.50 - includes healthy snack 3 Hour Session £17.00 - includes healthy snack Ad Hoc sessions available for £17.50 - includes healthy snack Pick up and drop off from local clubs £3 Breakfast club £10.00 (starting September 2026) 10% Sibling Discount

Week Commencing Monday 30th August 2026

Rows	Monday	Tuesday	Wednesday	Thursday	Friday
2 hour session (3.15pm - 5.15pm)
3 hour session (3.15pm - 6.15pm)
Ad Hoc Session (3.15pm - 6.15pm)
Pick up and drop off from local clubs
Breakfast club (as of September 2026)

Date of First Session

DayMonthYear
Date
Does your child attend ay local clubs or afterschool activities that require a pick up and drop off? (Charged at £3 per session) Please state days, times and location and contact details of organisation. Subject to approval from Captain Teds*
Pick up/ Drop off charged at £3
Permissions
Do you give permission to administer medication?
Do you give permission for local outings (ie Gosforth Park)
Declaration
Child's Name

First NameLast Name
I confirm that the above information is accurate and I agree to the terms and policies of Captain Ted’s.
Date

MonthDayYear
Date
Name of Parent/ Guardian

First NameLast Name
TERMS AND CONDITIONS.

Payment due: 1st of the month

Payments accepted via: Bank Transfer or Stripe

Late Fees: Late pickup charges apply at £5 per 15 minutes after the booked time.

Applicants will be accepted and reviewed based on availability. We operate an equal opportunities policy but reserve the right to refuse applicants if we believe that we cannot meet their individual requirements based on the level of staff training and ratio requirements.

Cancellations and Refunds:

48 hours notice required for cancellation of single sessions

Non-attendance without notice is non-refundable

30 days notice required for cancellation of services

Captain Ted’s Afterschool Club Registration

Child's Details

Parent's /Guardian's Details 1

Parent's /Guardian's Details 2

Emergency Contact Details

Child's Doctor

About Your Child

Afterschool Club - Select Session Dates

Permissions

Declaration

All About Me