COOL KIDS
Out of School Limited
(Formerly Kids Mix)
                                                                                                                                         
CHILDREN'S DETAILS

Child's Name:                                                                                                                               

Date of Birth:                                             Age:                               Gender:                               

School Attended:                                                                                                                         

Parent/Carer's Full Name:                                                                                                           

Home Address:                                                                                                                            

                                                                                                                                                    

Tel Nos:  Home:                            Work:                              Mobile:                                             

Other Emergency Contact Details:                                                                                              

                                                                                                                                                     

Relationship to Child:                                                                                                                   

Doctor's Name, Address and Tel No:                                                                                           

                                                                                                                                                    

Details of any significant health issues:                                                                                       
Please include any special educational needs and/or physical disabilities.

Please list any otherinformation you think we should now about. *If none, please state "None"
eg:  Likes  *  Dislikes  *  Allergies  *  Dietary requirements  *  Etc.
                                                                                                                                                     
Do you consent to members of staff at Clubb applying suncream to your child in hot conditions?
                                    YES  /  NO   *Please delete as appropriate*

Sessions requires:            BREAKFAST CLUB                       AFTER SCHOOL CLUB                                                MON/TUE/WED/THUR/FRI             MON/TUE/WED/THUR/FRI

                                          COMMENCEMENT DATE:                               
I have Read, Understood and Hereby Accept the Conditions of Cool Kids and agree to abide by them.

Signed                                                                   Dated                                    
PARENT/CARER              MANAGER                    DISCUSSED & AGREED