Sherington School Wrap Around Services
Please complete this form for each child that you require wrap around care for.
Email *

Childs Details:

Child’s surname: 
 *
Child’s first name: 
 *
Date of birth
 *
MM
/
DD
/
YYYY
Current Class
 *
Parent / Carer details:
If applicable please provide contact details for both parents- if this does not apply please type NA

Parent/ Carer 1 name

 *
Parent/ Carer 1 address 
 *
Parent/ Carer 1 Mobile number
 *
Parent/ Carer 1 Work number
 *
Parent/ Carer 1 Email
 *
Relationship to child *
Parent/ Carer 2 name
 *
Parent/ Carer 2 address 
 *
Parent/ Carer 2 Phone number
 *
Parent/ Carer 2 Mobile
 *
Parent/ Carer 2 Email
 *
Relationship to child
 *
Please provide details of an alternative contact that has permission to collect your child in case of an emergency if we are unable to contact either of the above contacts  
Emergency contact name *
Emergency contact address *
Emergency contact phone number
 *
Emergency contact mobile number
 *
Emergency contact work number
 *

Medical / Dietary needs: Please state below if your child has any medical or dietary needs. E.G. asthma /allergies.

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