Child Information

If you are new or returning to Rebecca’s Out of School Club, we need you to complete this form.

Rebecca’s Out Of School Club Child Information Form

Please complete the secure online form below or download, complete and return to us the Word or PDF Child Information Forms





Mrs.Ms.Miss.Mr.Dr.



YesNo

Emergency Contact Information


Mr.Mrs.Ms.Miss.









Mr.Mrs.Ms.Miss.








Other information required

Allergies


YesNo



YesNo

Food/Drinks (especially fruit and snacks)


Activities


Language


YesNo


Religion


Festivals


Health


Asthma/breathing problems YesNo
Skin conditions YesNo
Hearing difficulties YesNo
Sight difficulties YesNo
Speech difficulties YesNo
Any long term illness/conditions YesNo







Arrival/Departure

List the names of anyone (other than parents) who will be delivering/collecting your child.


Mrs.Ms.Miss.Mr.Dr.









Mrs.Ms.Miss.Mr.Dr.









YesNo.


Any other information


Signature



Rebeccas out of school club child information form
Rebeccas hout of school club child information form
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