Summer School Registration Form

Programme Registering For

Parent/Guardian Name

Phone

Child's Full Name

Date of Birth

Day

Month

Year

School & School Year (September 2026)

Emergency Contact Name

Emergency Contact Number

Relationship to Child

Who is authorised to collect your child from the programme?* Your child will only be released to authorised adults listed on this form.

Does your child have any medical conditions, such as allergies etc?

Does your child require medication during programme hours? Please provide details below:

Are there any additional educational, emotional or wellbeing needs we should be aware of?

What would you most like your child to gain from the programme?

*To help us tailor support to your child, please send copies of end-of-year reports, recent assessments or examples of school work where available. Email: hello@learningclubs.com WhatsApp: 07911 712250

Photography Consent

Yes, I consent

No, I do not consent

I authorise LearningClubs staff to seek appropriate medical assistance should an emergency arise and I cannot be contacted immediately.