Before and After School Club Admissions

Please select the club you wish to register for: *

Child's Name: *

First

Last

Date of Birth: *

1. PARENT/CARER NAME: (Please state the name of who has legal contact and who has parental responsibility for your child): *

Relationship to Child: *

Parent/Carer Contact Number (Home): *

Parent/Carer Contact Number (Mobile): *

Parent/Carer Contact Number (Work): *

Emergency Contact? *

Yes
No

2. PARENT/CARER NAME: (Please state the name of who has legal contact and who has parental responsibility for your child): *

Relationship to Child: *

Parent/Carer Contact Number (Home): *

Parent/Carer Contact Number (Mobile): *

Parent/Carer Contact Number (Work): *

Emergency Contact? *

Yes
No

Alternative Emergency Contact Full Name:

Relationship to Child:

Alternative Emergency Contact Number (Home):

Alternative Emergency Contact Number (Mobile):

Alternative Emergency Contact Number (Work):

Before School Club – (Please select days required – excl. Little Thurrock):

After School Club – (Please select days required):

Please provide a preferred Start Date: *

In line with the 'General Data Protection Act 2018' please provide an email address to receive invoices, promotional emails and newsletters from us: *

I agree to abide by all of the Terms & Conditions and Policies and Procedures laid out by Jules et Lis Out of School Clubs? *

Agree

Name *

First

Last

Date *

Before and After School Club Admissions

Before and After School Club Registration Form