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 name (required)

Mr.Mrs.Ms.Miss.

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

Post Code

Telephone contact information:
Home:
Work:
Mobile:

Email address:

Full fees will be charged for absence

If existing parents are just updating the contract a deposit does not need to be paid

Any special requirements or passwords for pick up?

If you have/would like your child/children to attend Merdon breakfast session and wish to drop them off in the car park we need written authorisation for Jenny Knight to sign them in.

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 Merdon Junior School on the following days:

Breakfast Session (7:30am - 9:00am) £5.75 (siblings £5.50)

Afternoon Session (3.30pm - 6:00pm) £12.00 (siblings £11.50)

Please select wich session you would like to book on which days:

Monday:        BreakfastAfternoon
Tuseday:        BreakfastAfternoon
Wednesday:  BreakfastAfternoon
Thursday:      BreakfastAfternoon
Friday:           BreakfastAfternoon

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. We will be closed on inset days for Merdon Junior School.

Please make a £30, non-refundable, deposit to register your child's place.
Please make cheques payable to: TJHP Ltd or Rebecca’s Out Of School Club or bacs account number 02514205 or sort code 30-92-94.

I have made payment of the non-refundable deposit

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):

Date YYYY-MM-DD: