After School Club - Brewood Middle School - Year 5 ONLY School Road, Brewood, Stafford, ST19 9DSTHURSDAYS, 16th September - 9th December 2021 Collection at 5pm Total cost for the Autumn Term £72.00, payment options availablePlease note, there is now a £2 surcharge for payment made by instalments, this has been added to the 1st paymentChild's Name* First Name Surname / Family Name School Year*Please select the School Year your child is in5Name of Parent/ Guardian* First Name Surname / Family Name Email*Please provide the email address that you would like ALL correspondence to go to.Mobile*Please provide one mobile phone number that you can be contacted on in the event of an emergency during EKO Club.Does your child have any medical or dietary conditions that we should be aware of?* No Asthma or Bronchitis Severe Allergies requiring an EPI pen Other Allergies OtherPlease give more details of your child's medical or dietary condition if necessaryIn the event of a minor accident and when I cannot be contacted, I agree for First Aid to be administered by a qualified First Aider.* Yes NoI give my consent for photographs of my child to be used for EKO displays incl. internet site and facebook.* Yes NoI wish to be kept informed of other EKO activities and events.* Yes NoI understand my child will be expected to wear a waterproof jacket, trousers and wellies, with additional warm clothing (hats, gloves etc.), for colder months.* YesI can confirm that my children’s clothing and footwear will be clearly named and, if not, I give permission for EKO to name them. YesAt the end of EKO club my child will be* Collected from EKO Club by a parent/carer Staying in school for additional after school provision Leaving school independentlyPlease contact us if any of these details change.Please check you have chosen the correct school and key stage (if appropriate). If correct please tick 'yes'*You can check this by looking at the page title at the top of this page. Yes, I have checkedAs the parent/guardian I have read, fully understand and am satisfied with the details supplied regarding EKO Club activities and agree for my child to take part in them.*Ticking 'Signed' means you have electronically signed for this. SignedBilling InformationPlease enter your billing informationFirst Name*Last Name*Email*Address*Address 2Town/City*County*Postcode*Country*Autumn Term Payment Options*£38.00 - First Instalment for Autumn Term£72.00 - Total Payment for Autumn Term£0.00 - Child in Receipt of Pupil PremiumIf you have chosen to pay by instalments you will receive an invoice for £36.00 for the second instalment of the Autumn Term in October. This Invoice will be emailed to you via PayPal, you DO NOT need to complete an additional booking form.