Breakfast Club for September 2020

Breakfast Club for September 2020

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1. CHILD'S DETAILS *

First Name	*
Surname	*
Date of Birth	*
Address Line 1	*
Address Line 2	*
Post Code	*

2. CHILD'S DETAILS *

First Name	*
Surname	*
Date of Birth	*
Address Line 1	*
Address Line 2	*
Post Code	*

4. PARENT'S/CARER'S DETAILS *

First name	*
Surname	*
Address Line 1	*
Address Line 2	*
Post Code	*
Telephone Number	*
Mobile Number	*
Email address	*

5. Relationship to child *

Mother
Father
Other (please specify):

6. BREAKFAST CLUB REQUIREMENTS

REC-Y6 FEES:
£5 per child per session
NURSERY FEES:
£8 per child per session *

7. I would like my child to attend Breakfast Club starting from: *

	DD/MM/YYYY

8. I would like my child to attend Breakfast Club: *

Ad Hoc
Long term

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