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Wrap Around Care Survey
ONLINE APPLICATION FORM FOR HOLIDAY CLUB
*
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
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 tick for Holiday Club Only
*
Holiday Club Only
We will confirm your start date once your application form has been processed.
I have read and agreed to the Greenway Nursery Rainbow Club 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
Home
Nursery Care
Greenway Nursery
SEND
EYFS and Curriculum
Tapestry - Online Learning Journal
Wrap Around Care
Rainbow Club
Rustington Funstars
Littlehampton Beachstars
Information
Safeguarding, Contact, Ofsted & Online Safety
Calendar & Weekly Activities
Aims, T & Cs, Policies & Flexiblity
Meet the GNRC Team
Gallery & Testimonials
Food Menu (all settings)
Children's area
Payment Information
Jobs at GNRC
Surveys
>
Wrap Around Care Survey