After School Registration

Please complete the following registration information for each child taking part in the STIR IT UP after-school club at Ellingham Primary on Wednesdays.

It is important you read our terms and conditions. Click here to read them.

Name of pupil

First Name

Last Name

Date of Birth

YYYY

Parent's Name

First Name

Last Name

Parent's Email Address

Mobile number

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

First emergency contact name

First Name

Last Name

First Emergency Contact Number

Second emergency contact name

First Name

Last Name

Second Emergency Contact Number

Has your child got any food allergies we need to be aware of?

If Yes, please give details

Has your child got any special educational needs we need to be aware of?

If Yes, please give details

Has your child got any dietary requirements we need to be aware of?

If Yes, please give details

Does your child carry an inhaler?

Does your child carry an EPI-PEN and know where it is?

Is there any other medical information we need to be aware of?

Is your child allowed to walk or cycle home on their own after the club?

Our staff are first-aid qualified, do you consent to your child receiving first aid? Stir It Up will alert the school staff when necessary.

In addition to thorough hand washing, due to COVID-19 we will require all attendees to use anti-viral hand foam prior to the class starting. Please confirm that you accept this.

Please confirm you have read and agree to our Terms and Conditions.

I agree to the STIR IT UP terms and conditions.