Please specify if you wish for your child to attend on a regular or occasional basis:
Regular attendanceOccasional attendance
Child's name (required)
Parent/carer's first and last names (required)
Child's date of birth (required) (YYYY-MM-DD)
Address of child's residence (required)
Post Code (required)
Address of parent/carer's residence if different to child
Telephone contact information:
Any special requirements or passwords for pick up
By submittting this form, I/we hereby enter into the agreement that the above child is to attend Rebecca's Out Of School Club for Scantabout Primary School.
Breakfast Session (7:30am - 9:00am) Â£5.50 (siblings Â£5.25)
Afternoon Session Early (3:20pm - 5:00pm) Â£9.50
Afternoon Session Late (3:20pm - 6:00pm) Â£11.50
Please select which session you would like your child to attend days:
Monday: BreakfastEarly AfternoonLate Afternoon
Tuseday: BreakfastEarly AfternoonLate Afternoon
Wednesday: BreakfastEarly AfternoonLate Afternoon
Thursday: BreakfastEarly AfternoonLate Afternoon
Friday: BreakfastEarly AfternoonLate Afternoon
I/We would like attendance to commence on (YYYY-MM-DD)
Four weeks notice to terminate this arrangement or fees paid in lieu. Rebecca's Out Of School Club reserve the right to withdraw its services if any fees remain unpaid for more than 1 week. You will be given four weeks notice of this and not charged.
Please make a Â£30, non-refundable, deposit to register your child's place by either:
1) making a BACS payment to TJHP Ltd T/A Rebecca's Out of School Club sort code 30-92-94 account number 02514205 or,
2) sending a cheque made payable to Rebecca's Out Of School Club to Rebecca's Out Of School Club, 34 Valley Road, Chandlers Ford, SO53 1GP
Please note: When a child is booked for an early afternoon session (3:20pm. 5:00pm) any collection after 5:00pm will result in an additional Â£2.00 charge being made. If however, they are picked up after 6p.m. another fee of Â£10 per every 15 minutes will be charged.
Tick to indicate your agreement to comply with Rebecca's Out Of School Club policies and procedures.
I have read and comply with Rebecca's policies and procedures.
Have you submitted your Child Information form?
I have completed a Child Information Form.
Have you submitted your Parental Permission form?
I have completed a Parental Permission Form.
Signature (Please type your name):
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