Requests are dealt with in order they are received. Please take a note of the sessions you have requested as once this form is completed you will not be able to see it again. Any changes required once this form has been submitted should be made by email to starclub@springfieldprimary.net
Please do not fill this form in again unless it is for another child.

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* 1. Child's Surname

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* 2. Child's first name

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* 4. Child's Date of Birth

Date

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* 5. Password - For safeguarding purposes, please provide a password. (STAR Club should be notified in advance by email with the person's name and relationship to the child if an adult other than the named parents/carers will be collecting your child).

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* 6. Media Images - STAR Club may take photo's to use for promotional purposes either on the Springfield Primary School website or in STAR Club newsletters. Only first names will be used. I give permission for my child to be included in promotional photographs whilst attending STAR Club.

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* 7. Medical - Please detail below if your child has any of the following:- 
Medical Condition
Allergy
Uses an Inhaler
Special Educational Needs 
If your child has none of the above, please type "None"

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* 8. Dietary - Please detail below any dietary requirements eg. Vegan, Halal, No red meat etc.
If they have no dietary requirements, please type "None"

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* 9. Bookings - Please advise which of the following options you require

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* 10. What regular weekly sessions would you like to book?

Breakfast Club is 7.30am to 8.50am. After School Club is 3.10pm to 5.45pm.

  Breakfast Club After School Club Breakfast Club and After School Club
Monday
Tuesday
Wednesday
Thursday
Friday

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* 11. Start date (applicable to Regular weekly sessions only)

Date

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* 12. Please select a Collection time for each day you have requested regular weekly sessions in After School Club

  4.15pm 4.45pm 5.15pm 5.45pm
Monday
Tuesday
Wednesday
Thursday
Friday

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