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?
Does your child already attend this club?
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
Child's Ethnicity
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
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.
If yes, please give details.
Does your child have any medical or mobility support needs? For example wheelchair user, or has diabetes.
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.
If yes, please give details. E.g. Halal
Is your child a young carer?
Is your child a refugee or asylum seeker?
Are you happy for your child to be photographed for future promotion on Grand Junction's website and social media?
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:
Are you receiving universal credit or housing benefit?
Where did you hear about us?

Other
Do you want your email to be added to our mailing list? You will receive monthly emails about other programmes at Grand Junction.
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
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
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
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:
Parent/carer Signature
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