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*

MonthDayYear
Date
Age on September 1st 2025 *
Gender*

MaleFemalePrefer not to say
School Attending in September 2025*
First Language*

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
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship to Child
Contact 2*

First NameLast Name
Emergency Contact Mobile Number*

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship to Child*
Password if someone else collects your child*

Child's Doctor
Name of Doctor*
Doctor's Number*

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
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 *

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.*

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Date*

MonthDayYear
Date
Name of Parent/ Guardian*

First NameLast Name
TERMS AND CONDITIONS.

Payment due: Before 20/7/2025

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
Non-attendance without notice is non-refundable.
All About Me

Insert a photo
This is me aged
The most important people in my life are
My favourite things are
My favourite food is
My favourite books/ tv shows/ movies are
I am afraid of/ dislike
Should be Empty:

	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

Child's Details