Breakfast Club Registration Form

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Please use this form to register for Breakfast Club .

Child's Name: *

Date of Birth: *

AAAA

School: *

Horndean C of E Junior School

Horndean Infant School

Infant School Children Only

I confirm my child is aged 5 or above

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Home Address *

Emergency contact details to be used during Breakfast Club hours (7.30am to 8.40am) Contact Name: *

Emergency contact details to be used during Breakfast Club hours (7.30am to 8.40am): Relationship to child: *

Emergency contact details to be used during Breakfast Club hours (7.30am to 8.40am): Contact number: *

Emergency contact details to be used during Breakfast Club hours (7.30am to 8.40am): Email address: *

Child's Doctors Surgery: *

Surgery contact number: *

Is there anything we need to know about your child's health or welfare (including allergies)

Parent's Name: *

I confirm I give parental consent for my child to attend Breakfast Club *

I confirm

I confirm I have read and agree to the terms and conditions on the school website *

I confirm

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