eg 07956607645 Emergency phone number will receive txt info about the course please share info.

eg 07956607645 Second Emergency phone number will receive txt info about the course please share info.

Please put N in the box if you are new to us so that we can arrange a special welcome.

Age in Years on first day of course

M = Male F = Female

R= Reception — Registers will contain year groups together.

What School do they attend?

Medical Details if any please fill in the Medical form ( link on Main page)

Early (£6) 8.30 – 10am & Extra Time (£6) 4.00-5.30pm Please put E or L or Both E/L Half day (4 Year olds) (£25) 9.30am-1.15pm put ‘H’ in box eg Tuesday 22 H

Enter number 1 if attending and and leave blank if not

Enter number 1 if attending and and leave blank if not . .

Enter number 1 if attending and leave blank if not .

Enter number 1 if attending and leave blank if not .

Enter number 1 if attending and leave blank if not

Enter number 1 if attending and leave blank if not

Enter number 1 if attending and leave blank if not

Enter number 1 if attending and leave blank if not

Enter number 1 if attending and leave blank if not

Enter number 1 if attending and leave blank if not

£160 for full 5 day ( M-F)week or £40 per individual day £6 for Early and £6 for Lates daily Please total £’s & complete payment by Bank Transfer (or CCV’s ) to worldcupsports.co.uk Barclays Sort 20-37-16 Acc. 00054879

Childcare Scheme Providers Name or Bank Transfer reference. PLUS Childs name & Venue OF- AY- MH. (Payment due 10 days prior to start) Please put relevant reference here to allow us to match it up to your child’s full name .Orley Farm Setting Reference Number: 2635987 Registration Number 2635986 for Skill & Sports Development.

Full Address please including post code