Registration Form for Invicta School Club

Student first name: *

Student surname: *

D.O.B: *

Age:

Preferred name:

Describe Gender:

Student's gender: *

Male

Female

Prefer to self-describe

Child’s Current School:

Class Name:

Year:

Home Address:

44 Jupiter grove Faversham

Post code:

Language(s) spoken:

Is English your child's first language?:

Primary contact first name: *

Surname: *

Relationship:

Address: *

44 Jupiter grove Faversham me13 8uu

Contact number: *

Work number:

Email address: *

Occupation:

Are there any other contact restrictions?:

Yes

Details:

Not to be collected by anyone unless we have informed staff

Secondary contact first name:

Surname:

Relationship:

Address:

8 ruins barn road sittingbourne me10 4hs

Contact number:

Work number:

Email address:

Occupation:

Custody of the child is with:

Primary contact

Secondary contact

Both (joint custody)

Other

Contact no.1 name:

Relationship:

Address:

44 Jupiter grove Faversham me13 8uu

Mobile number:

Work number:

Contact No.2 name:

Relationship:

Address:

8 ruins barn road sittingbourne me10 4hs

Mobile number:

Work number:

I, hereby consent and grant permission to the following persons to collect my child (Must be 18 years or over):

Myself
& philip yates
Elizabeth Tyler

Allergic reactions - Severity: *

Not Applicable

Very high

High

Medium

Low

Allergies, if any:

Medical conditions, if any:

Does your child have any dietary requirements?:

Yes

Special needs:

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

Yes

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

Needs full assistance with toilet and has no awareness of the dangers around her

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

None

Which Club Location are you registering for?:

Faversham

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

Any other instructions :

Registrations is by invitation only, if you have not been invited to register your account will not be approved. This form must be signed by the parent(s)/ guardian(s) with parental responsibility; applying for admission of the named child and who it is assumed will be responsible for the fees. For more details, please visit our website: Please send a copy of the child’s passport page to confirm the details. Additionally, include a copy of the child’s most recent school report to support your application. These attachments can be sent to community@invicta-cl.com quoting the child's name and the registration reference number that you will receive when you submit the application.

Declaration :

I accept the terms and conditions of [School Name]

Yes No

Full Name of Parent/Carer:

Digital Signature

Abbie Janes

Date & time:

23, Jan 2024 01:21 pm

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