Tick if EYFS child Just For Fun out of school club

Registration Form

Child’s Details Date of Registration:

First name:

Surname:What s/he likes to be called:Date of Birth and Current Age:

School attended:

First language:Key worker’s name:

Parent/Guardian details (Please inform us if either parent does not have legal parental responsibility)

Title:

First name:SurnameTitle:

First name:SurnameHome address:

Home address (if different):

¨ Tick if child normally lives at this address¨ Tick if child normally lives at this addressWork address:

Work address:

Home number:Mobile number:Work number:Home number:Mobile number:Work number:Email address:

Email address:

Alternative emergency contact details (please provide details of two people we can contact if we are unable to get hold of you)

Name:

Telephone number:

Mobile number:

Address:

Relationship to the child:

Name:Telephone number:Mobile number:

Address:

Relationship to the child:

Details of child’s doctor

Name of Doctor:
Address:

Telephone:

About your child

Please detail any additional/special needs your child has: (please provide full details)

Please detail any dietary requirements/ food allergies for your child: (please provide full details)

Is there anything your child doesn’t like (food, games etc) or is scared of?

What are your child’s favourite activities?

Signature of Parent/Carer Date:

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