Child's Name *

First Name

Last Name

Child's Date of Birth *

MM

DD

YYYY

Parent/ Guardian Name/s *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Checkbox for Food Allergies *

Does your child have any known FOOD allergies or any medical conditions, we should be aware of?

No

Yes

Checkbox for Dietary Requirements *

Does your child have any dietary requirements, we should be made aware of

Vegetarian

Pescatarian

No Pork (Halal / Kosher)

NONE

Additional Needs or Information *

Does your child have any additional needs, we should be aware of?

Yes

No

Does your child have a one to one support staff with them at school *

Please call 07936711013 if your child has a 1-2-1 in school as we may not be able to offer the specific care your child needs in club

Yes

No