Chillzone Before and After School Club Registration Form - September 2023

Please find below our Chillzone Before and After School Club registration form for September 2023.

Please note that we can only accept bookings for pupils in Reception through to Year 6.

If you have any questions, please contact the school office on 01782 235577.

Question Title

* 1. Child/rens Name/s

Child 1

Child 2

Child 3

Question Title

* 2. Date of birth/s

Child 1

Child 2

Child 3

Question Title

* 3. Please tick which Year Group your child/ren will be in in September 2023

Reception

Year 1

Year 2

Year 3

Year 4

Year 5

Year 6

Question Title

* 4. 1st Parent/Carer Details

Name

Company

Address

City/Town

Postal Code

Phone Number

Name of Employer (if applicable)

Employer Phone Number (if applicable)

Question Title

* 5. 2nd Contact Information

Name

Company

Address

City/Town

Postal Code

Phone Number

Name of Employer (if applicable)

Telephone number of employer (if app)

Question Title

* 6. Medical Contact Information

Doctors Name

Doctors Surgery Name

Address

Address 2

City/Town

Phone Number

Question Title

* 7. Childs Medical Information/Conditions

Child 1

Child 2

Child 3

Question Title

* 8. Special Requirements i.e. dietary, special needs (physical or other)

Question Title

* 9. Do you provide consent for (Tick all that apply);

First aid treatment

Emergency advice/treatment at hospital

Named photographs/video of your child

Publication of photos on the school website/materials

Question Title

* 10. Do you require morning sessions? (7.30am - 8.45am) £4 per session (Tick all that apply)

Monday

Tuesday

Wednesday

Thursday

Friday

Question Title

* 11. Do you require PM Session (3.15pm - 4pm) £4 per session (Tick all that apply)

Monday

Tuesday

Wednesday

Thursday

Friday

Question Title

* 12. Do you require PM Session (3.15pm - 6pm) £8 per session (Tick all that apply)

Monday

Tuesday

Wednesday

Thursday

Friday

Question Title

* 13. Can your child walk home alone after Chillzone? (This is only possible for Year 6)

Yes

Not applicable

Question Title

* 14. By submitting this form I agree that I have read and agree to the terms of Chillzone - our terms can be found at; Burnwood Website

Yes

Chillzone Before and After School Club Registration Form - September 2023

Question Title

* 1. Child/rens Name/s

Question Title

* 2. Date of birth/s

Question Title

* 3. Please tick which Year Group your child/ren will be in in September 2023

Question Title

* 4. 1st Parent/Carer Details

Question Title

* 5. 2nd Contact Information

Question Title

* 6. Medical Contact Information

Question Title

* 7. Childs Medical Information/Conditions

Question Title

* 8. Special Requirements i.e. dietary, special needs (physical or other)

Question Title

* 9. Do you provide consent for (Tick all that apply);

Question Title

* 10. Do you require morning sessions? (7.30am - 8.45am) £4 per session (Tick all that apply)

Question Title

* 11. Do you require PM Session (3.15pm - 4pm) £4 per session (Tick all that apply)

Question Title

* 12. Do you require PM Session (3.15pm - 6pm) £8 per session (Tick all that apply)

Question Title

* 13. Can your child walk home alone after Chillzone? (This is only possible for Year 6)

Question Title

* 14. By submitting this form I agree that I have read and agree to the terms of Chillzone - our terms can be found at; Burnwood Website

Question Title

* 15. Please provide a password to be used for collection of the child