ONLINE CLUB CONTACT FORM

Please select *

I am happy with all of the below I am happy to receive updates about Clare's Learning Club Mailing list for year 5 revision sessions and mock test I am happy to added to a class WhatAspp group administrated by my child's teacher for homework updates and short notice information

Name of child *

First

Last

Current School Year *

Child's Date of Birth *

Club attending *

School *

YEAR 5 ONLY: I give permission for my child to walk home alone after the class (face-to-face sessions) *

(Optional) Other relevant learning information: *

(Optional) Notes regarding Eleven Plus preparation so far (if any) *

Contact/ Billing Information

Select Fee Payment Option *

Parent/ carer name *

First

Last

Your email address *

Contact Number *

Relationship to child *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Contact Name *

First

Last

Emergency Contact Number *

People who will collect your child after the class (face-to-face sessions) *

Billing Name if different from above *

First

Last

Billing Email Address if different from parent/ carer *

Billing Contact Number if different from parent/ carer *

Medical

I will make sure that I am contactable throughout the entire time that my child is at Clare's Learning Club, or that I have given the club's teacher the contact details of someone else who can be contacted, so that in a medical emergency situation my child can be quickly collected and give the necessary medical attention.

I the parent/ guardian named above give permission to the Clare's Learning Club teacher to administer any relevant minor treatment or medication to the above name participant when or if necessary.

Permission for minor treatment or medication *

Doctor's Surgery *

Doctor's Telephone Number *

Please list any medical conditions and/ or allergies: *

Sweets and Treats

I give permission for my child to eat a small/ ice lollies/ squash amount of sweets during some sessions *

Please list any food allergies or restrictions *

Photography and Filming

I give permission for my child to be photographed or filmed at Clare's Learning Club for use on the Clare's Learning Club website, Facebook page and promotional materials. Occasionally some online sessions may be filmed to produce tutorials to be used at a later stage. During face-to-face sessions we may take photographs or videos of some games and activities.

Please select all or specify which you do or not give permission for.

YouTube *

Terms

I agree that fees will be paid in advance by the named person above before the start each half term and understand that unauthorised late payments will incur a £5 a week charge. *

CANCELLATIONS BEFORE STARTING AT CLARE'S LEARNING CLUB

If you cancel up to 7 days before your course starts, you'll receive a refund minus a £20 admin fee.
If you cancel within 7 days of the start of your course or once your course has started you will not be entitled to any credit or refund.
If you cancel, this must be received in writing by email.
Refunds are not issued for missed sessions unless in the unlikely event they cancelled by the club teacher.

If you no longer wish your child to attend Clare's Learning Club once they have started attending

You must give at least three weeks written notice by email before the end of the current half term or you will receive a £20 admin fee.
If you wish your child to stop attending during a half term you will not receive a refund for the remainder of that half term.
If you have a monthly payment plan charges/ refunds will be calculated pro rata.

I agree to a written notice period of 3 weeks before the end of the half term or 4 weeks notice before a year 5 additional session. *

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Parent/ Guardian Contact Form

Contact/ Billing Information

Medical

Sweets and Treats ​

Photography and Filming

Terms

Sweets and Treats