Form from: Broughton Junior School

After School Club Registration Form

An After School club for all Broughton children from Infant through to the Juniors.

Our after school club starts from 3.10pm – 5.45pm and children must be collected from the School Hall at Broughton Junior School.

Please clearly mark the days required.

Child's Name

Child's Class

Payment Information - £9.50 per child or £9.00 per child for siblings.  Payment is due by 4th April 2025.

Payments can accompany the booking, however full payment must be paid by the last day of term.

Fees may be paid either by cash, school money or approved voucher schemes.

I would like to pay via:

Government Voucher Payment Reference Code

Date voucher payment was/will be made

Please note we cannot refund payments without one week’s notice of cancellation. If your child is unable to attend a booked space, please contact the school on 01296 423276 to confirm absence.

Emergency Contact Details

Name:

Relationship to Child:

Address:

Telephone Number:

Medical Information (Please state any medical conditions your child has, i.e.; Allergies, Asthma, Diabetes)

Allergies:

Medical Conditions:

Prescribed Medication:

Should my child need to take medication for a life threatening condition - I authorise the staff to administer this medication as prescribed and on my written instruction only.

I give consent for the staff to administer first aid to my child

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Your email