Registration Form

PLEASE COMPLETE IN BLOCK CAPITALS

Child's Full Name

M/F

Child's Date of Birth

Age

Year Group

Parent/Carer Name

Address

Postcode

Contact Tel No.

Home

Work

Mob

Email Address

School Name

School Address

Postcode

Please provide details of alternative contact for your child in the event of us not being able to contact you in the unlikely

event of an emergency.

Name

Name

Address

Address

Contact Tel No.

Contact Tel No.

Relationship

Relationship

We need to ensure the safety of your child. To enable us to do so please provide the name and telephone number below

of any other person authorised to collect your child.

Name

Contact Tel No.

Please indicate if your child has any medical conditions or allergies:

Please indicate if your child has any additional special need:

Tick here if your child needs 1 to 1 support or you would like to give us more detailed information on a child profile form

Doctor's Name

Contact Tel No.

Please indicate your child's first language:

I confirm I have read and accept the Terms & Conditions

MF