Clifton-upon-Teme Primary School: Autumn Term 2021 Year 5/6 After School Sports Club Pupil Registration Form

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Please use this form to register your child's interest in the Year 5/6 Sports Club being run on Mondays after school. All questions are required to be filled in before you are able to submit this form.

Please note: The email address you give on this form will only be used for the specific purpose of generating an automatic confirmation of your submitted details, and will be deleted from the database linked to this form within 3 weeks of the final session of the club.

Email *

Child's First Name: *

Child's Surname: *

Emergency Contact Details:

Emergency Contact 1: Name and Telephone Number/s *

Emergency Contact 2: Name and Telephone Number/s: (optional)

Indicate below any medical issues e.g Asthma or any other important information that you feel is important for the instructors to be aware of: *

No medical issues

Yes - these are detailed below

Required

Please indicate below who will be picking up your child after the club. Use their full name and their relationship to your child e.g. mum, dad, older sibling: *

Please tick the box below to indicate that you give permission for your child to attend the Year 5/6 After School Sports Club *

Yes - I give permission for my child to attend the above sports club

Required

Send me a copy of my responses.

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