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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