Jay Dee Wraparound Care Application Form
James Dixon Primary School provides wraparound care for our full-time Reception to Year 6 pupils.

In the morning children are offered a healthy breakfast. After school, children are given the space to play, read, or do home learning and offered a hot meal.

* Morning sessions are Monday to Friday 7.15am until the start of the school day at a cost of £4.00 per day.
* Evenings are Monday to Friday 3.00pm until 6.00pm at a cost of £14.00 per day
* Parents wishing to book full wrap around care - mornings and evenings for 5 days is £70.00

Payments are to be made on ParentPay, you will need to top up the account and make sure sufficient funds are in the account in advance, payments will be deducted daily upon agreed days you choose, unless the school is closed. You must commit to a term in advance.

PLEASE NOTE: Late fees will apply after 6pm and Wraparound Care is not open on the last day of term when children finish at 2pm.

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Email *
Child’s First Name *
Child’s Surname *
Child's Year Group & Class as of September *
Child’s Date of Birth *
MM
/
DD
/
YYYY
Child’s Gender *
Child’s Home Address (with postcode) *
Is English the first language, if No, please provide your child’s first language under Other *
Are there any other sibling/s who is already in the Wraparound Care, if Yes please list their name/s under Other *
Adult 1:Title and Full Name *
Adult 1:Home Address *
Adult 1:Email Address *
Adult 1:Country of Origin *
Adult 1:Mobile Phone *
Adult 1:Home Phone Number *
Adult 1:Occupation, workplace name & telephone number *
Adult 2:Title and Full Name *
Adult 2:Home Address *
Adult 2:Email Address *
Adult 2:Country of Origin *
Adult 2:Mobile Phone *
Adult 2:Home Phone Number *
Adult 2:Occupation, workplace name & telephone number *
Who has parental responsibility for the child *
What best describes your family structure *
Are there any Court Orders relating to your child, if Yes, please provide details under Other *
Is your child looked after by a Local Authority. If Yes, please provide which Authority under Other *
Name, Address and Telephone Number of family doctor *
Has your child been diagnosed with any of the following *
Required
Has your child been prescribed medication for their condition, if Yes, please provide details of the condition and prescribed medication under Other *
Should the medication be kept in school for cases of emergency, Epi-pen or inhaler, if Yes, please make sure you bring this on the child’s first day *
Does your child have an Educational Health Care Plan *
Is your child on the SEN support register *
Has your child had any involvement from outside agencies *
Required
Does your child need to wear glasses in class *
Does your child need to wear a hearing aid *
Does your child have any specific dietary needs for medical or religious purpose, if Yes, please provide details under Other *
Ethnic Background *
Religion *
Emergency Contact 1 (Name, Number & Relationships) *
Emergency Contact 2 (Name, Number & Relationship) *
Please indicate who will be the child’s main contact for email correspondence, please provide email address for one parent/carer *
Please indicate who you would like to receive text correspondence, please provide mobile number, this can be up to two number for a parents/carers *
If you do NOT give photo and video consent, please check this box
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I will be using a tax free childcare account/vouchers to pay for the wraparound care. If Yes please provide details under Other… *
Days required *
Jay Dee's Breakfast
Jay Dee's After School
Not Required
Monday
Tuesday
Wednesday
Thursday
Friday
Terms and Conditions *
Required
Name of Parent/Carer *
DECLARATION - By submitting the form I declare that the information that I have provided is correct to the best of my knowledge and I will inform the school of any changes.

A copy of your responses will be emailed to the address you provided.
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