YMCA Booking Form for Breakfast Club – (2017)

Breakfast & After School Club
at St John Fisher Catholic V.A. Academy
Breakfast Club – 7.40am – 8.40am
£4.00 per day (includes breakfast)
After School Club – 3.15pm – 5.45pm
£7.00 per day (includes a light tea)
Take part in our fun activities!
Sports & Games
including:
Dodgeball
Benchball Hockey
Football
Badminton
Tag Games
Arts & Crafts
Games
Construction toys
Quizzes & Competitions
Bingo
There will also be opportunities for children to complete
homework and reading with support from the YMCA Staff
Team.
• All Children from Year R – Year 6 welcome
• For breakfast, choose from our selection of cereals and
toast with a variety of jams.
• After school a light tea is offered which may include
sandwiches with a choice of fillings, crisps,
cake/biscuit/yogurt and fruit. (Menu available on request)
• Fruit squash and water available to drink each session.
• Delivered by Miss Allen and other highly trained and
experienced YMCA staff. All fully DBS checked and cleared.
• Suitable footwear required for sports and games in the hall
• For more information call Miss Allen on 07753 435915
St John Fisher Breakfast & After School Club
Booking form
Please complete this form, cut off and return along with full payment in a named
envelope to your school office as soon as possible.
Payment can be made by cash or cheque, payable to YMCA Derbyshire’.
BACS and Child Care Voucher payments can be arranged by request.
Child’s name:
Child’s class & DOB:
Parent’s name:
Contact number:
MONDAY
Date
24th
1st
8th
15th
22nd
AM
TUESDAY
PM
CLOSED
Date
25th
2nd
9th
16th
23rd
AM
WEDNESDAY
April
PM
Date
AM PM
th
26
May
rd
3
10th
17th
24th
THURSDAY
Date
27th
4th
11th
18th
25th
AM
FRIDAY
PM
Date
28th
AM
5th
12th
19th
26th
No. of breakfasts =
Total due for breakfasts =
£
No. of after school sessions =
Total due for after school sessions =
£
Total amount due =
£
Payment method (please circle)
Cash / Cheque / BACS / Child Care Vouchers
I agree that full payment must be made and a registration form completed before my child
attends St John Fisher Wraparound Care.
I understand that sessions maybe cancelled without charge or changed up to seven days before
my child is due to attend St John Fisher Wraparound Care. Any changes made after this are liable
for full payment.
Signed: _____________________________________________
Parent’s name: _______________________________________
PM
724
children signed up for
sports camps in summer 2015
1250
children received
PE lessons through our PPA
cover last year
984
attendances over
52 days of Y-Play play scheme
provision
30
children mentored
as part of the Priority Families
scheme
YMCA Derbyshire
770 London Road
Wilmorton
Derby
DE24 8UT
T 01332 854647
www.ymcaderbyshire.org.uk