Registration Form for Bree's Little Stars

Child’s first name: *

Child’s surname: *

D.O.B: *

Preferred name:

Age: *

Gender: *

Male

Female

Class: *

Finish Time: *

Primary contact first name: *

Surname: *

Relationship: *

Address: *

Flat 402 Nara Building

Contact number: *

Work number:

Email address: *

Occupation:

Surname:

Secondary contact first name:

Relationship:

Address:

71 Little Cottage Place
Greenwich
London SE10 9LG

Contact number:

Custody of the child is with:

Primary contact

Secondary contact

Both (joint custody)

Other

Email address:

Occupation:

Work number:

Address: *

43 Malt Kiln Place
Dartford

Relationship: *

Contact no.1 name: *

Mobile number: *

Work number:

Contact No.2 name:

Relationship:

Address:

FLAT 27 SIR FRANCIS DRAKE COURT 
10 BANNING STREET 
GREENWICH  SE10 0FF

Mobile number:

Work number:

I, hereby consent and grant permission to the following persons to collect my child (Must be 16 years or over): *

Joyce Nwidag, 07903831076, password
OR
Joyce Nwidag 07903831076 (password- plantain)

Doctor's name: *

Surgery address: *

234 Wickham Lane
Plumstead
SE18 5tf

Allergens severity: *

Very high

High

Medium

Low

Surgery phone Number: *

Allergen's Name:

Medical condition(s) if any:

Does your child have any dietary requirements?: *

Yes

Special Dietary Needs:

No egg

Medication (Please list any medication your child takes regularly and the dosage):

N/A

If your child has any learning difficulties/disabilities or requires additional assistance, please list them here:

He has autism

Does your child have any special educational needs (SEN)?: *

Yes

Any other relevant information we may need to be aware of ?:

No

Religion:

Christian

Muslim

Buddhist

Jewish

Sikh

Hindu

None

Prefer not to say

Others - please state

Any other relevant information:

Also understands Tagalog/Filipino

Other Religion:

First language:

English

Secret password: *

Please read our Terms & Conditions View T&C's

Any other instructions : Our Terms and Conditions have been emailed to you, if you have not received them please email club.holiday@breeslittlestars.co.uk:

Declaration :

I accept the terms and conditions of Bree's Little Stars

Yes No

Full Name of Parent/Carer:

Digital Signature

Adele

Date & time:

07, May 2021 11:57 am

Bree's Little Stars

Child Details

Parental Responsibility

Emergency Contacts

Medical Info

Other Details

Consents

Terms of Service