Afterschool Club Registration Form

Afterschool Club Registration Form
Parent Details
Parent Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: 07000 000000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How many children do you want us to look after?
Name of school(s)
What time do you want use to look after your child?
Who will collect the child ? & their names
Child Details

Fill in the details below
First Name*   Last Name*   Date of Birth*   Age*
*
Medical Information
*  If so, please give details
GP name & surgery *
Any dietary requirements/allergies: Yes   No*
If so, please give details
Photos & Permissions (we will not take pictures of the child's face, only a faceless picture of them doing activities)
I give permission for my child to be photographed during activities
Yes   No *
Child 2

Fill in the details below
First Name   Last Name   Date of Birth   Age

Medical Information
  If so, please give details
GP name & surgery
Any dietary requirements/allergies: Yes   No
If so, please give details
Photos & Permissions (we will not take pictures of the child's face, only a faceless picture of them doing activities)
I give permission for my child to be photographed during activities
Yes   No
Child 3

Fill in the details below
First Name   Last Name   Date of Birth   Age

Medical Information
  If so, please give details
GP name & surgery
Any dietary requirements/allergies: Yes   No
If so, please give details
Photos & Permissions (we will not take pictures of the child's face, only a faceless picture of them doing activities)
I give permission for my child to be photographed during activities
Yes   No
Child 4

Fill in the details below
First Name   Last Name   Date of Birth   Age

Medical Information
  If so, please give details
GP name & surgery
Any dietary requirements/allergies: Yes   No
If so, please give details
Photos & Permissions (we will not take pictures of the child's face, only a faceless picture of them doing activities)
I give permission for my child to be photographed during activities
Yes   No
Emergency Contact Details

Fill in the details below
Person 1
Full Name * Phone Number* Relationship*
Person 2
Full Name Phone Number Relationship
Emergency Medical Consent

In the event of an accident, illness, or medical emergency, authorised members of staff may need to arrange appropriate medical treatment for your child.
I give permission for staff to seek emergency medical treatment if required:
I confirm the information provided is correct
Date

MonthDayYear
Date
Signature
Pay £10 Deposit & Secure Your Child's Place
prevnext( X )
Deposit
A £10 deposit is required for each child, it will be taken off your first payment.

Please select the number of children you are registering.

£10 Number of Children

Total

£0.00
Should be Empty:

Afterschool Club Registration Form

Parent Details

Child Details

Child 2

Child 3

Child 4

Emergency Contact Details

Emergency Medical Consent

I confirm the information provided is correct

Pay £10 Deposit & Secure Your Child's Place*

Pay £10 Deposit & Secure Your Child's Place