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*mandatory information

Child / Contact Details

Child's Details

Child's Address

Contact Details:

Contact Address

if different from child

Child's Primary School Details

Child's Primary School Details

General Sessions

Please complete the table below with your required sessions

  Monday Tuesday Wednesday Thursday Friday

Collection Arrangements

Please detail any person authorised to collect your child from the club. Please note if a child is not collected by 6pm a member of the team will begin to contact the parent/carer and emergency contacts after 5 minutes and until contact is made. If no contact is made within 45minutes the Police/Social Work department will be contacted and the child passed over to their care.

Collector 1 Details

Collector 2 Details

Collector 3 Details

Emergency Contacts

Please detail below any other person(s) authorised to be contacted in an emergency:

Emergency Contact 1 Details

Emergency Contact 2 Details

Emergency Contact 3 Details

Medical Information & Special Particular Needs

Please make sure you make the coach aware if your child has any medical conditions or special needs.

Doctors Details:

Child's Illnesses or Allergies

Child's Dietary Requirements

Child's Medication Requirements

Consent Requests

Terms and Conditions

Please note all information provided on this form will remain confidential.