After School Care Registration Form

Your Information

Name of child* Class* Name of parent/carer 1* Contact number of parent/carer 1* Address* Name of parent/carer 2* Contact number of parent/carer 2* Address (if different to above)

Emergency Contact Information

Contact 1

Name of emergency contact 1* Contact number of emergency contact 1* Email address contact 1* Address of emergency contact 1* Relationship to child*

Contact 2

Name of emergency contact 2* Contact number of emergency contact 2* Email address contact 2* Address of emergency contact 2* Relationship to child*

Medical Information

Please give any details of any known medical conditions Please give details of any known food allergies or dietary requirements

I consent to staff seeking emergency medical treatment of my child during the club*YesNo

Declaration

I have read the information on the website and I would like to register my child for after school careI agree, please register my child