Parents Name

Email Address

Home Address

Contact Number

Emergency contact number (if different from above)

Name and DOB of Child Attending

Name and DOB of Child Attending

Name and DOB of Child Attending

What Year is your child in?

Class Name

Year 1/Year 2 Class Location Year 1/Year 2 Class Location Pirate ShipMiddle Pickett Fence RH doorMiddle Pickett Fence LH doorFar Corner PickettClass closet to bottom exit

Session You Are Booking Session You Are BookingOne Off SessionFull Term

What day(s) would you like to visit?

Would you like pick up from school or will you be dropping off? Would you like pick up from school or will you be dropping off?Pick up From St. LawrenceDropping off @poponin

What time does your childs school day end?

Time you will pickup your child Time you will pickup your child5.00pm5.30pm6.00pm

Who will be collecting your child?

Doctors Name and Address

Please advise if your child has any allergies. Please advise if your child has any allergies. No Yes

If you answered Yes to the above please provide details.

Do you know if your child has had a reaction to 'arts and craft' materials ie paints, glue, glitter etc. Do you know if your child has had a reaction to 'arts and craft' materials ie paints, glue, glitter etc. No Yes

Is your child allowed a snack and drink whilst at poponin? Is your child allowed a snack and drink whilst at poponin? Yes No

Payment Terms Payment TermsOne Off Booking (daily rates)Full Term In Advance (attracts reduced rate)Full Term Split MonthlyFull School Year In advance (full school year, attracts reduced rate plus 3% discount)

Costs Costs£16.00 up to 5.00pm/£17.50 up to 5.30pm/£21.00 up to 6.00pm (daily rates)£15.75 up to 5.00pm/£16.50 up to 5.30pm/£20.00 up to 6.00pm (monthly payment scheme))£14.75 up to 5.00pm/£16.00 up to 5.30pm/£19.50 up to 6.00pm (full term in advance)

poponin take photos/video for promotional purposes. Are you OK with your child being in photos/video? poponin take photos/video for promotional purposes. Are you OK with your child being in photos/video? Yes No

Would you like to receive the poponin newsletter? Would you like to receive the poponin newsletter? Yes Already receiving No

Please use this space for any other information you think useful or helpful to the poponin team. Thank You.

Please Confirm Please Confirm I confirm I have read the Terms and Conditions*