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Application Form for BC and ASC

Please indicate which service(s) you are requesting:

Emergency Treatment
In the event of a serious illness/ accident, staff will contact the Emergency services and the parents and carer’s will be contacted.

I give permission for my child to receive emergency treatment at the BC/ASC or Hospital in line with the Guidelines*
Is your child allergic to plasters?*
Please tick if relevant*

Please select the days you wish your child to attend:

Breakfast Club
After-School Club

• I understand that the fees must be paid half-termly in advance.
• If I do not pay the fees as agreed my child’s place will be withdrawn.
• I understand that fees are non-refundable during sickness or absence.
• Two weeks’ notice to be given if child is leaving the club.
• Please ensure that all children are collected on time. Parents / carers are reminded that persistent late arrival to collect children may lead to the place being forfeited. As late collection incurs an additional staffing cost of £10 per 15 minutes (or part of lateness), this may be passed on to the parent / carer.