Afterschool Club Registration

Afterschool Club Registration Form
Thank you for your interest in our Afterschool Clubs!
Please fill in the form below in as much detail as possible. The Grand Junction team will be in touch via email to confirm your registration.

We do ask for some information which may seem sensitive. We have to gather data for our funders to keep our classes free. All data is stored securely and any information shared with our funders is made anonymous.
Afterschool Club

Please let us know which club you are registering for. You may select more than one if your child is the right age!
Which term are you registering for?*
Which Grand Junction Afterschool Clubs would your child like to attend?*

Junction Juniors (ages 7-11) Monday 4-5:30Junior Climate Champions (ages 7-11) Tuesday 4-5:30Dance for Girls (ages 9-15) Tuesday 4:30-6Youth Club (ages 8-13) Wednesday 4-6:30
Does your child already attend this club?*

My child is newMy child already attends
Participant Details

Please give us information about the child you are registering. We collect this data to best support your child in the sessions and to report to our funders.
Child's First Name*
Child's Last Name*
Child's Date of Birth*

DayMonthYear
Date
Child's Gender*

MaleFemaleNon Binary
Child's Ethnicity*

IndianPakistaniBangladeshiChineseAny other Asian backgroundArabAfricanCaribbeanAny other Black, Black British, or Caribbean backgroundEnglish, Welsh, Scottish, Northern Irish or BritishIrishGypsy or Irish TravellerRomaAny other White backgroundWhite and Black CaribbeanWhite and Black AfricanWhite and AsianAny other Mixed or multiple ethnic backgroundAny other Ethnic GroupNone of these apply/I want to give more detail below
Please use this box to describe your ethnicity, if the above options do not relate to you.
For example: Mixed, Romanian and Nigerian
Child's school*
Child's School Year *
For example: Year 3
Street Address*
For example: 103 Rowington Close
Post Code*
For example: W2 5TF
Borough you live in*

WestminsterBrentRoyal Borough of Kensington and ChelseaCamdenOther, please write below.
If you do not live in any of the boroughs listed above please state your borough
For example: Islington
Does your child have SEND, behaviour that challenges, mental heath and emotional needs, or any other additional needs that we should know about? For example autism.*

YesNo
If yes, please give details.
Does your child have any medical or mobility support needs? For example wheelchair user, or has diabetes.*

YesNo
If yes, please give details.
Does your child have any allergies, food intolerances or dietary requirements? Please note, we often offer young people snacks including fruit and biscuits during our classes and, during Youth Club, the children get a light meal.*

YesNo
If yes, please give details. E.g. Halal
Is your child a young carer?*

YesNo
Is your child a refugee or asylum seeker?*

YesNo
Are you happy for your child to be photographed for future promotion on Grand Junction's website and social media?*

YesNo
Main Parent/Carer Details
Parent / Carer First Name*
Parent / Carer Last Name*
E-mail*
example@example.com
Parent / Carer Phone Number*
07986 543 210
Parent employment status:*

Currently workingCurrently not working
Are you receiving universal credit or housing benefit?*

YesNo
Where did you hear about us?*

FlierSocial MediaThrough friends/familyOn our websiteWhatsapp GroupGrand Junction NewsletterOther
Do you want your email to be added to our mailing list? You will receive monthly emails about other programmes at Grand Junction.*

YesNo
Additional Adult Contact Details

We must have more than one adult to call in case you are uncontactable in an emergency. Please put at least one other adult’s contact details below. This could be your partner, an aunt, grandparent, neighbour, or a friend who may also collect your child.
Additional Adult 1 Name:*
Additional Adult 1 Phone Number:*
07986 543 210
Relationship to your child (additional adult 1):*
Grandparent / Best friend's mum
This adult may collect my child if I am unavailable*

Yes
Additional Adult 2 Name:
Additional Adult 2 Phone Number:
07986 543 210
Relationship to your child (additional adult 2):
Aunt / Neighbour
This adult may collect my child if I am unavailable

Yes
If you arrange for somebody other than the adults listed above to collect your child, you will need to send us their details on the day they will collect instead.
My child attends other after school clubs*

YesNo
We do ask that families agree to the following so that our sessions run smoothly and that all participants are safe.
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
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
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Afterschool Club Registration Form

Afterschool Club

Participant Details

Main Parent/Carer Details

Additional Adult Contact Details