2018-19 Breakfast Club Application Form
Please complete this form if you would like to apply for a place in the new academic year 2018-19.

Please complete a separate form for each child.

The Breakfast Club is for children attending full time primary education aged:  4 - 11 years of age and runs from
7.45 – 8.55 a.m.   The cost is £6.50 per session, per child.

No child will be accepted at the club until the club has received a fully completed application form and half-term payment in advance (unless otherwise agreed). Payments must be made through parent pay or child care vouchers only.

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Child's Forename *
Child's Legal Surname *
School Site *
Class (from September 2018) *
Please select which days you would like your child to attend
Preferred start date *
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Please list any dietary requirements your child may have. *
If your child has no dietary requirements, please type "None"
Please list any medical requirements or allergies your child may have. *
If your child has no medical requirements or allergies, please type "None"
Will you pay for Breakfast Club with Childcare Vouchers? *
If you intend to pay with Childcare Vouchers, please enter your provider's name
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