Brookfield Wrap Around Care Provision
Please complete this form by Monday 13th December 2021 if you would like to apply for a place in our extended services from January 2022.  We will write and confirm places by Friday 17th December.  

Please refer to our Terms and Conditions attached to the email for your reference.

The sunrisers breakfast club runs from 7.30am until 8.45am. Cost £5.50 per session
The Sunsetters after school club runs from 3.10pm latest time to collect is 5:45pm. Cost per session £13.00

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My child currently attends the Jancett Extended Services Provision
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Child's First Name *
Child's Surname *
Date of Birth *
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Child's Year Group *
Child's Class *
Child's Address *
Name of Parent/Carer *
Contact Telephone Number *
Email Address *
Name(s) and Telephone Number(s) of Person(s) Authorised to Collect
Name *
Telephone *
Relation to Child *
Name
Telephone
Relation to Child
Name
Telephone
Relationship to Child
Medical Details
Child's Doctor's Name *
Telephone *
Address *
Please state if your child has any known medical problems or allergies *
Please state if your child has any dietary requirements/known food allergies/major dislikes *
I agree to my child having access to the internet as per the school's E-safety policy *
I agree to my child's photo being used in displays and on the website *
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