Southville Clubhouse Registration Form

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Southville Clubhouse is an OFSTED registered wrap-around care provider for children aged between 5 and 11. Our services are designed to be "parent friendly" and fit in with your lifestyle either as a working parent or as a parent who wants a break. Our commitment is to provide a very high standard of care for your children in line with the latest regulations.

This children are looked after by caring and well-trained staff in a cheerful, safe and secure environment.

This form is made of four parts - the child's information, the parents information, emergency contacts and medical/other information - and should take about 5-10 minutes to complete. Please contact aftercare@southville.hounslow.sch.uk if you have any questions.

Child's First Name *

Child's Surname *

Child's Gender

Male

Female

Clear selection

Does your child attend Southville Primary School? *

Yes

Child's Class

Child's Date of Birth *

YYYY

Address *

Time Slots Required

Monday

Tuesday

Wednesday

Thursday

Friday

Breakfast Club

Afterschool Club

Are you planning on attending Holiday Club?

Yes

Clear selection

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