Xtra Time Leavesden Green JMI School & Nursery Booking Form - Spring 1

This booking form is a Term Time Booking form which should only to be completed once at the beginning of each Half Term if you know what days you consistantly require. This booking form is NOT to be completed multiple times.

All other bookings are deemed short notice bookings (Ad Hoc Bookings). Short notice Ad Hoc bookings are subject to availability, please call your Provision Manager before completing an Ad Hoc form to confirm your child's collection.

To make a short notice Ad Hoc booking please click here.

Breakfast Club Manager: Coach Greg - 07746 945 903

After School Club Manager: Becky - 07380 935 279
Great news! We have extended our discounted rate for Wake Up & Shake Up Club until the end of Autumn Term 2 in the hope it will drive numbers for the breakfast club. Please note: If numbers do not increase, we will revert back to the original Wake Up & Shake Up Breakfast Club prices as per communication sent by Leavesden Green School to the parents/carers and the beginning of the academic year. Please share this news and take advantage of the discounted rates.
Xtra Time Registration Requirements

Xtra Time do not charge a registration fee for children that attend less than three sessions in an academy year. This is to support parents who need one off childcare without having to pay a registration fee in addition to an Ad Hoc booking fee for a one off booking.

T&Cs do apply: All parents/carers must complete a Registration Form before their child can attend. Whether your child attends one session or is regular booker, every child must have a completed Registration Form along with their booking before their child can attend our clubs.

Once your child has attended three sessions (AM or PM) parents/carers will need to pay their Registration Fee. Majority of parents/carers are regular bookers and know their child will attend more than three sessions in an academic year (September 2025 to July 2026) and therefore pay their registration fee on submission.

Click here to complete our Registration Form.

*Please note: Bookings submitted without a completed Registration Form submission will not be accepted.
Have you completed a Xtra Time Registration Form for your child?*

Yes - I have completed a Registration Form for my childNo - Please complete a Registration form before continuing
If you have ticked 'Yes' above but have not completed a Registration Form, your child will NOT be allowed to attend the club.
IF THIS IS YOUR FIRST TIME USING XTRA TIME YOU WILL NOT BE REQUIRED TO PAY THE LATE PAYMENT FEE - PLEASE CONTACT STAFF PRIOR TO BOOKING.
Please note: Children who attend Leavesden Green Junior School will always be dropped off to school after breakfast club by an Xtra Time member of staff and collected from school for the after school club.
Child's Name:*

First NameLast Name
Child's School:*
Child's Year:*
Child's Class:*
EpiPen
It has been advised by our First Aid Trainers that we should administer a second dose of EpiPen 5-15 minutes after the first dose if the child does not feel better. It also allows critical time for the ambulance crew to get to the session. If your child requires an EpiPen, your child must have TWO EpiPen's with them at all times. By ticking this box you are confirming that you will send your child in with two EpiPen's. Failure to do so will result in Xtra Time sending your child to the school office. Your child will not be able attend the session until they have two EpiPens. This is to safeguard your child and Xtra Time Kidz Club Staff.*

I confirm that I have read and understand the above.
Medical Condition(s):*
Does Your Child Have Any SEN:*
Does your child have any SEN (Special Educational Needs)?
Details of Medical Condition(s) / SEN:*
Please provide details of any medical condition(s).and/or Special Additional Needs. For example:Asthma and/or ADHD
Parent's Name:*

First NameLast Name
Parent's E-mail*
example@example.com
Emergency Contact 1:*
Mobile number
Emergency Contact 2:*
Full Address:*

Street Address

TownCounty

Postcode
Collected By:*
Name of person collecting your child
Relationship To Child:*
What is their relationship to your child
Security Key/Code*
Chose a security key/code of your choice that'll be used if somebody else collects your child
The costs for the sessions are as follows:

Breakfast Club: £7.00 (this session runs from 07:30 to start of school)

After School Club: £16.00 (this session runs from end of school to 18:00)

Late booking fee: Great News! We have removed the late booking fee.
* Please note: There is an Inset Day on Monday 6th of January. If you require childecare services for this date please click here.

We will be running a Multi Sports and Activity Camp at Nascot Wood Junior School on:

Mon 23rd - Fri 24th Dec and Thurs 2nd - Mon 6th Jan (This is purely numbers dependant) Booking deadline is Friday 13th Dec - This is upon the school's request.
Week 1 - W/C Monday 5th January
Week 1 - Wake Up / Shake Up Breakfast Club

MondayTuesdayWednesdayThursdayFriday
Week 1 - Extended After School Club

MondayTuesdayWednesdayThursdayFriday
Week 1 Total £
Week 2 - W/C Monday 12th January
Week 2 - Wake Up / Shake Up Breakfast Club

MondayTuesdayWednesdayThursdayFriday
Week 2 - Extended After School Club

MondayTuesdayWednesdayThursdayFriday
Week 2 Total £
Week 3 - W/C Monday 19th January
Week 3 - Wake Up / Shake Up Breakfast Club

MondayTuesdayWednesdayThursdayFriday
Week 3 - Extended After School Club

MondayTuesdayWednesdayThursdayFriday
Week 3 Total £
Week 4 - W/C Monday 26th January
Week 4 - Wake Up / Shake Up Breakfast Club

MondayTuesdayWednesdayThursdayFriday
Week 4 - Extended After School Club

MondayTuesdayWednesdayThursdayFriday
Week 4 Total £
Week 5 - W/C Monday 2nd February
Week 5 - Wake Up / Shake Up Breakfast Club

MondayTuesdayWednesdayThursdayFriday
Week 5 - Extended After School Club

MondayTuesdayWednesdayThursdayFriday
Week 5 Total £
Week 6 - W/C Monday 9th February
Week 6 - Wake Up / Shake Up Breakfast Club

MondayTuesdayWednesdayThursdayFriday
Week 6 - Extended After School Club

MondayTuesdayWednesdayThursdayFriday
Week 6 Total £
Please note: On Wednesday 20th December, the school closes early. If you have selected for your child to attend on this day, there will be an additional £10 charge for the extended service for the After School Club.
Late booking fee

Applied £20.00
Late Booking Fee £
Late booking fee applied after deadline
Grand Total:
Payment Method:*

Bank Transfer - Please follow the instructions belowChild Care Vouchers - Please select your provider below
Childcare Voucher Provider:*

CO-OP - 85116843EDEN RED - P20733006KIDDIVOUCHERS - EY444153CARE4 - 18475662BUSYBEES - XTRA TIME KIDZ CLUBCOMPUTERSHARE - 0020197568RG CHILDCARE - 97926708410FIDELITI - XTR001CFAIRCARE - XTHO0218TAX FREE CHILDCARE SCHEME - Ofsted No: EY444153ENJOY BENEFITS - WD18 9QDSODEXO - 850954OTHER - Provide details in additional comments box
Please make your booking payment in full to the account below:

It is soley the parent/carers responsibilty to make the booking payment in full. If your child's payment has not been made in full to the account specified above, we cannot secure your child's booking.

Once you have made your payment in full, please include your payment reference and payment date below.
ALL PAYMENTS MUST ONLY BE PAID INTO THE ACCOUNTS LISTED ABOVE AS EACH XTRA TIME SERVICE HAS ITS OWN SPECIFIED ACCOUNT. THIS HELPS US TO ALLOCATE YOUR PAYMENT. IF YOUR PAYING BY CHILDCARE VOUCHERS AND YOUR PROVIDER IS NOT LISTED ABOVE PLEASE CONTACT US.
Payment Reference:*
XTLeavesden - Child's Name
Payment Date:*

DayMonthYear
Date
Please attach a screenshot of your payment below.*

If you are unable to attach a screenshot of your payment, please write the details of your payment on a piece of paper stating the reference, date and amount paid. Providing this enables our finance team to easily find your payment and avoid the need to contact you. Please do not contact us to confirm if your payment has been made. We will contact you if there are any issues with your payment. Your submission of this form and confirmation email is confirmation of your booking.
Cancelof
Please Note: You will not get a confirmation message from Xtra Time Kidz Club when you have processed your payment. If there are any issues with the payment, a member of our finance team will get in contact.
CHILDCARE VOUCHER PAYMENTS MUST BE PAID IN FULL ON THE DATE YOUR BOOKING FORM IS SUBMITTED. THE EXACT PAYMENT AMOUNT ON YOUR BOOKING FORM MUST BE MADE IN FULL, USING THE REFERENCE ABOVE. IF THIS PROCESS IS NOT FOLLOWED YOU WILL NOT HAVE SECURED YOUR CHILD'S BOOKING, AND YOUR CHILD WILL NOT BE ABLE TO ATTEND THE CLUB.
Additional Comments:
Do you give consent to Xtra Time Kidz Club to take pictures of your child which will ONLY be used for marketing purposes (Social media platforms, www.xtratime.co.uk, flyers and other advertising purposes).*

YesNo
Do you follow us on Social Media?*

YesNo
Thank you for following us on social media.
Please Like, Share and Subscribe to our social media platforms by clicking on to the images below.
We are offering an exclusive £25 off Birthday Party Bookings to all existing customers, would you like the Xtra Time team to help plan your child's next birthday party?*

Yes (Contact me)No
Would you be interested in a variety of Private One-to-One / Group Tuition for you or your child? Focusing on upskilling, mental health, well being, weight loss, confidence and more. Please Click herefor more information*

Yes (Contact me)No
Community Give Back
If you are in need of further support, please fill out our enquiry form and a member of our team will be in contact with you to see how we can assist. https://form.jotform.com/230514567489364. All throughout the year, Xtra Time strives to help as many families in the local community as possible, and in particular we have a big push for the Christmas period. In the past we have helped over 300 families by providing food, amenities and toiletries and every year, we want to be able to provide even further support*

I have read the above.
Please sign here before clicking the 'Submit' button below: *

Clear
* Please note: Duplicate bookings and payments being charged twice are solely down to the Booker clicking the submit button more than once, all fees incurred for processing a refund will be payable by the person who made the booking. To avoid any inconvenience, please be patient while your booking is being processed.
GDPR

YES
Date

DayMonthYear
Date
Should be Empty:

EpiPen

Week 1 - W/C Monday 5th January

Week 2 - W/C Monday 12th January

Week 3 - W/C Monday 19th January

Week 4 - W/C Monday 26th January

Week 5 - W/C Monday 2nd February

Week 6 - W/C Monday 9th February

Community Give Back