Wraparound Care Registration Form

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If you would like your child to attend either of our wrap around care clubs at Plaistow and Kirdford Primary School, please complete the form below. If you have more than one child who will be attending, please complete a different form for each child. This form needs to be completed one time only per child annually.

Email *

Child's Name *

Date of Birth *

YYYY

Child's Class *

I confirm that I will update the school should any of the details provided in this form change at any time. *

Yes, I agree

Required

Main Contact Name *

Main Contact Telephone No. 1 *

Main Contact Alternative Telephone Numbers

Second Contact Name *

Second Contact Telephone No. 1 *

Second Contact Alternative Telephone Numbers

Other Contact Names and Telephone Numbers

Doctor's Name *

Doctor's Telephone Number *

Dietary Requirements. Does you child not eat particular foods for religious reasons or because they are a vegetarian, vegan or have allergies? *

None

Religious

Vegetatian

Vegan

Allergy

Other

Required

Dietary Requirements. If you ticked one or more of the below (except none), please provide further information below.

Medical Information - allergies and medication *

My child has an epipen in school - please provide details below

My child has an inhaler in school - please provide details below

My child has a food allergy - please provide details below

My child has another allergy - please provide details below

Other medical - please provide details below

My child does not have any additional requirements or allergies

Required

Medical Details - please provide details if your child has any allergies or medical requirements that our team should be aware of.

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