Activity card registration form -

Activity card registration form -

Activity Card Registration

To be completed by the Activity Card Holder (child or young person) or an adult on their behalf and returned to

the School . Eligible children are those registered for Free School Meals or who are children in care.

Child’s Full Name

Activity Card Number

Includes numbers and letters

School Name

Child’s Home Address and Postcode


Date of Birth

Date of Birth:



Child’s Home Telephone Number

If more providers join the list or there are special offers available at short notice we will use your email address

or text to your mobile to inform you.

Parent’s Email

Pupil’s Email

Mobile number

We would like to give your name and the number of the card you have been issued to our providers so that

they can easily book you onto activities. Please tick this box to show you give permission for the providers to

know your name.

In accordance with our responsibility under Data Protection legislation, you should be aware that the personal

information that you are giving on this Form, will be held electronically and may be passed to other Services of

the Council, so that you are provided with the best possible support. The information may also be passed to

external individuals or organizations, but only where this is essential to provide the service or there is a legal

obligation to do so. In all cases the information you provide will be stored and used in a secure and appropriate

manner in accordance with the Data protection Act. If you wish to access the personal data held about your

child, then please contact: The Information Compliance Officer, Strategic Intelligence, Room L10, County Hall,

Topsham Road, Exeter, Devon EX2 4QZ

I have ticked this box to show I give permission for the providers to know my name and for this

information to be held by the Learning Community Extended Services Coordinator and I agree to abide by

the rules surrounding the use of the card listed on the factsheet.

What do you do out of school at the moment? (please tick as applicable)


Free School Club eg sports coaching


Free Activity eg youth club, bike ride


Free Activity eg walk, library visit


Paid Activity eg music lesson


Paid Activity eg swimming, cinema


Paid Activity eg residential

What type of activity would you like to do in the holidays and after school?

Tick the boxes next to the activities you would like to do, your answers will help us to plan new activities.

Adventure Sports –

Climbing, mountain boarding, go carting

Water Sports –

Surfing, kayaking, windsurfing

Martial Arts –

judo, karate

Team Sports –

football, rugby, volleyball, basketball, netball


Crafts –

pottery, sewing, woodwork

Arts –

painting, drawing, sculpture

Trips and visits ‐

gallery, museum, cinema

Dance –

Street dance, ballet, contemporary, tap,

jazz, cheerleading





Horse Riding

Your ideas:

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