Welcome to Twickenham's Before &

After-School Club Booking Form.

Please complete for:

Summer Term 1

Parent First Name *

Parent Last Name *

Relationship To Child *

Other Parental Responsibilities?Name/No./Relationship to child

Address

Street Address

City

Post Code:

Parent Email *

Parent Number *

I Consent to Receive SMS Notifications, Alerts & Occasional Marketing Communication from The KSA Group. You can reply STOP to unsubscribe at any time.

1st Child's First Name *

1st Child's Last Name *

1st Child's Date of Birth (DD/MM/YY) *

2nd Child's First Name

2nd Child's Last Name

2nd Child's Date Of Birth (DD/MM/YY)

3rd Child's First Name

3rd Child's Last Name

3rd Child's Date Of Birth (DD/MM/YY)

Religion *

Ethnic Origin *

Child's Doctor *

Surgery Address *

Surgery Tele *

Medical and Behaviour Information

Please inform us of any relevant history of medical needs, difficult behaviour, ADHD, toileting requirements

I give permission for my child(ren) to receive medical treatment *

Yes

If there are any treatments you wish for your child not to receive?

Emergency/Legal Contacts

We require at least one other alt. to the parent/carer's details: *

Name
Landline
Mobile
Relationship to child

Consent

I give my consent for the mentioned child to participate in: *

The KSA Group works closely with local inspection units. With their help we make every effort to ensure the safety of your child whilst in our care and it is our duty to report any suspicion of abuse or neglect. I accept The KSA Group policies and procedures and agree to pay the appropriate charge for my childcare fee's, should I not make payment I will be liable for legal action against me to recover costs and additional legal fee's.

Parent Signature *

Clear

Parent Name

Date of form completion

Whats Next?

Claire will be in touch to take payment. Your booking wont be confirmed until payment has been received. You will also receive our full terms and conditions of the booking.