Registration Form

05/10/2023

Breakfast & After School Care

"*" indicates required fields

Child's Name*

First name Surname

Gender

Date of Birth*

Parent/Carer's Name 1*

First name Surname

Mobile phone number*

Home phone number

Work phone number

Email address*

Parent/Carer's Name 2

First name Surname

Mobile phone number

Home phone number

Work phone number

Email address

Family Home Address*

Address Line 1 Address Line 2 Adress Line 3 Post Code

Emergency Contact Name & Number (must be different to parent/carer above)*

Name of person(s) with permission to collect your child*

Please nominate a one-word password that we can use in the event that we are unable to identify the person collecting your child (e.g: ‘purple’)*

Childcare Vouchers & Tax Free Childcare Payments

If you are using either of these methods to pay for wraparound care, please provide details here...

Medical, Dietary & Special Needs

Please include with your registration any further information concerning your child’s needs, including any Special Needs, Medical Conditions and Dietary Requirements.*

Behaviour Statement

Children are expected to behave in accordance with St Thomas Becket behaviour policy. If a child demonstrates inappropriate behaviour, the Headteacher has the right to withdraw that child.

Requesting a place at the wrap around care club constitutes acceptance of the following:*

Cancellations can only be made up to (but not later than) 48 hours after the booked session is due to commence

Pupils will receive a substantial snack rather than a main evening meal at the after-school club (see handbook for full details)

Late collection incurs a cost of £5 per 5 minutes

Signature*

Full name and realtionship to child*

Today's Date*