Child's Name:

Childs D.O.B:

Address:

Is your child a pupil at SMH:
yesno

Parent Name:

Email:

Tel No:

Does your child have any dietary requirements?
yesno

Does your child have any medical conditions?
yesno

Date of your child’s last tetanus injection:

Emergency Contact:

Emergency Contact Number:


Dates – Please tick to register which weeks you wish to send your child(ren).
Monday 8th July – Friday 12th July 2019Monday 15th July – Friday 19th July 2019Monday 22nd July – Friday 26th July 2019Monday 29th July – Friday 2nd August 2019Monday 5th August – Friday 9th August 2019Monday 12th August – Friday 16th August 2019

Please use the space below to detail any additional information you would like to provide.

We take your privacy seriously and will only use your personal information to administer your account your account and to provide the products and services you have requested from us.

However, from time to time, we would like to contact you with details of our special offers and promotions. If you consent to us contacting you, for this purpose, please tick to say how you would like to be contacted.