Student Registration Form- 4th July INSET day
Please complete the form in full and we will be in touch shortly with further information. Please only complete the form once!
1st child
*
Full name
Age
2nd child
Full name
Age
Parents name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
Post Code
Parents E-mail
*
example@example.com
Parents contact number
*
Please enter your mobile number
Does your child require lunch buffet & snacks? (additional cost of £3.50 per child)
*
YES
NO
Does your child require wrap around?
*
AM- 8am-9am
PM 3pm -6pm (join after school club for the evening)
NONE
Dietry requirements / allergies / medical information
Do you consent to Shout Out! taking photographs and video footage of your child taking part in the workshops to use for promotional purposes?
*
Yes
No
ORDER FORM- ONLY SELECT FROM HERE IF PAYING VIA PAYPAL OR YOU CANNOT SUBMIT FORMPlease choose to book via Paypal using this form or choose a different option below. IF NOT PAYING VIA PAYPAL, PLEASE DO NOT SELECT ANY OF THE OPTIONS HERE AND PROCEED TO THE LAST QUESTION AND PRESS SUBMIT
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( X )
1st Child booking
1st child cost
£
35.00
Quantity
1
AM wrap around
Please choose this if you would like to drop off from 8.30am
£
2.50
Quantity
1
2
3
Sibling - 2nd + child
Please choose this option for the 2nd + child
£
30.00
Quantity
1
2
3
PM wrap around
Your child will join our after school club and can stay until 6pm Sandwiches and snacks are provided
£
11.50
Quantity
1
2
3
Lunch Buffet & snacks
Please choose this if you require food for your child
£
3.50
Quantity
1
2
3
I would rather pay via bank transfer of childcare vouchers. (you do not need to go through Paypal checkout for this option)
Childcare vouchers
direct bank transfer
Cash
Pay with PayPal
Please click one of the PayPal options to complete payment and
submit
the form.
Submit Application
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