Lions Breakfast Club Application Form

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Please complete this form if you wish to apply for a place at our Breakfast club. Breakfast club opens from 7.50am and all children are to be brought in by their parent and signed in.

Please complete one form per child.

Daily fee for regular sessions is £6.00 per child. Ad hoc sessions are charged at £7.00.

All fees must be paid in advance. Fees are still payable should your child not attend. Please ensure that you advise the school office or Lions directly on 07542 793393 if your child is not going to attend a session.

Child's name *

Date of birth *

YYYY

Gender *

Male

Female

Address *

Parent 1 name *

Parent 1 mobile no *

Parent 2 name *

Parent 2 mobile no *

Emergency 3 contact name *

Emergency 3 mobile no *

Days you wish to attend *

Mondays

Tuesdays

Wednesdays

Thursdays

Fridays

Required

Medical needs or allergies *

GP Name and contact *

Anything else we need to know *

Consents

I agree to my child receiving medical advice and treatment in an emergency

I agree to my child's photograph being used in line with the main school policy

Submit

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