Number of Children*:
---12

Parent Name*:

Email*:

Phone*:

Postcode*:

Child 1 Name*:

Child 1 D.O.B* (dd/mm/yy):

Child 1 Emergency Contact Number*:

School*:

School Year*:
---reception123456

Medical Info*:

Dietary Requirements*:

Special Educational Needs/Disability*:

Does your child benefit from 1to1 support in school?*:
 Yes No

Child 2 Name:

Child 2 D.O.B (dd/mm/yy):

Child 2 Emergency Contact Number:

School:

School Year:
---reception123456

Medical Info:

Dietary Requirements:

Special Educational Needs/Disability:

Does your child benefit from 1to1 support in school?:
 Yes No

Additional Info:

Do you agree to photos to be taken of your child for marketing and promotional materials?  Yes No

Do you agree to your child/children walking to and using the facilities at one of our Partner Sites? (see risk asssessment for more info)  Yes No

Do you agree to information being stored and processed for communication purposes in accordance with GDPR?  Yes No

Please tick to state you have read and agree to our COVID19 Risk Assessment.  Agree

Please tick to state you have read and agree to our Terms and Conditions.  Agree