Greenway Nursery & Rainbow Club
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ONLINE APPLICATION FORM
*
Indicates required field
Parent / Carer #1
*
First
Last
Parent / Carer #2
*
First
Last
Email
*
Email
*
Home Phone Number
*
Mobile Phone Number
*
Address
*
Child's Year Group & Class Name
*
For Example: R, Navy Class
Child Name
*
First
Last
Child's full name
Date of Birth
*
Child's Date of Birth
Select One
*
Male
Female
Please provide 2 Emergency contacts other than the parents, just in case we can't get hold of you as a first contact. For example, grandparent, next door neighbour
Emergency Contact #1
*
Name, Phone Numbers and Relationship to Child ( different contact to above)
Emergency Contact #2
*
Name, Phone Numbers and Relationship to Child ( different contact to above)
Name & Telephone no: of Family Doctor
*
In the case of an emergency, it might be necessary to obtain urgent treatment for your child from a doctor, dentist or hospital casualty department. As delay in such circumstances is to be avoided, in the unlikely event of GNRC Limited not being able to contact you, we ask that you give your consent thus: “In the event of a sudden illness or accident affecting my child, I agree to emergency treatment if recommended by a doctor, including any operative treatment and/or administration of a general anaesthetic.”
Has your child got any special dietary requirements or allergies?
*
Yes
No
If Yes, please give further information
*
Emergency Medical Consent Given
*
Yes
No
See Consent Statement
Has your child got any medical needs?
*
Yes
No
If Yes, please give further information
*
Please indicate below whether you are happy for us to apply factor 50 sensitive sun-cream to your child at Funstars.
*
Yes
No
Please select the sessions that you require from below
Price List
Breakfast Club £5.00
After School Club £10.95
Both Clubs on the Same Day
£13.95
Monday
*
Breakfast Club (7:30 - 8:50)
After School Club ( 15:15 - 18:00)
Both Clubs
Tuesday
*
Breakfast Club (7:30 - 8:50)
After School Club (15:15- 18:00)
Both Clubs
Wednesday
*
Breakfast Club (7:30 - 8:50)
After School Club (15:15 - 18:00)
Both Clubs
Thursday
*
Breakfast Club (7:30 - 8:50)
After School Club (15:15 - 18:00)
Both Clubs
Friday
*
Breakfast Club (7:30 - 8:50)
After School Club (15:15 - 18:00)
Both Clubs
Please tick for Holiday Club Only
*
Holiday Club Only
Start Date Required
*
We will confirm your start date once your application form has been processed.
I have read and agreed to the GNRC Terms and Conditions.
*
Yes
No
I consent to photographs of my child being used online and on GNRC's literature.
*
Yes
No
Please tell us how you found out about us
*
Submit