Peter Hills Church of England School

 Extended Day Provision Application Form

 

Extended Day Provision

Please complete all fields marked (*)

Your first name *

Your last name *

Your email *

Child's Name *

Year Group *

Nursery Reception Year 1 Year 2 Year 3 Year 4 Year 5 Year 6

Home Address *

Main Contact Name *

Main Contact Number *

Secondary Contact Name *

Secondary Contact Number *

Does your child have any allergies?

Please give explanation to allergies - symptoms, treatment, medication etc.

Please detail any dietry requirements your child has.

Please detail any medical conditions your child has.

I give consent for my child to be included in any photographs taken

I give consent for my child to be filmed

I give consent for my child's photo or video to be used on the school's social media feed and website

I give permission for my child to go on local visits during the extended day hours

Please let us know the regular days your child will be attending extended day

Please provide a signature.