Queen’s Manor French Club - Term 2 - Year 2 / Year 3

Please complete a separate registration form for each child.

Child's details

Picture

Your file must be a .jpg or .png and can't exceed 2mb.

First name

Last name

Gender

Date of birth

Age

Grade

Level of French
BeginnerIntermediateFluent

Parent/Guardian's details

Contact 1

Name

Relationship to child

Address

Postcode

City

Phone

E-mail

Contact 2

Name

Relationship to child

Address

Postcode

City

Phone

E-mail

Select club - Term 2 - from w/c January 13th to w/c March 24th

Club	Price
Year 2 - Year 3 Wednesday 3.30pm	£
Total	£

In case of cancellation, fees will be refunded in full up to two weeks before
the beginning of the term.

There will be no refund if the cancellation is made less than two weeks before
the term starts.

Medical information

Please indicate any health information/behaviour issues that would be beneficial for staff to know when
working with your child:

Allergies

Regular medications

Restricted activities

Special needs? If yes, please describe below:

Emergency Contact Details

Name:

Relationship to child

Address

Postcode

City

Phone

E-mail

I declare that the above information is correct and that I acknowledge that Douce France London Ltd is not responsible for any consequences resulting from incorrect or incomplete information.