Breakfast Club Permission Form

Child's Name* Year Group and Class*

I would like my child to attend the Breakfast Club held at All Souls' CEP School.

I confirm that I will pay £2 for each session in advance of my child attending via

www.schoolmoney.co.uk

I am aware that Breakfast Club starts at 7.45am and finishes at 8.30am. Please note food will not be served after 8.25am.

Medical Information

Please state if your child has any allergies* Please state if your child has any medical conditions*

In the event of my child needing emergency treatment and the Headteacher or her representative being unable to contact me, I consent for the member of staff accompanying my child to approve the application of emergency treatment, including anaesthetic advised by the medical authorities for the well-being of my child.

Signed (Parent/Carer):* Date:*

Families with more than one child attending - Please ensure a separate form is completed for each child.

All Souls' Church of England Primary School

Breakfast Club Permission Form

Medical Information

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