Email address About your child Child's first name Child's last name Gender GenderMaleFemale Date of birth (e.g._01/04/1980) Name of school Does your child receive free school meals? Does your child receive free school meals?YesNo Free school meals code (This can be obtained directly from your child's school) Special educational need/ Spectrum conditions (Please list) Does your Child have a spectrum diagnosis? Does your Child have a spectrum diagnosis?YesNo Is your child receiving SENCO support from their school? Is your child receiving SENCO support from their school?YesNo Does your child have a EHCP (Educational Health and Care Plan) Does your child have a EHCP (Educational Health and Care Plan)YesNo Emergency Contact Details Emergency Contact Details 1 Contact number Relationship to child Emergency Contact Details 2 Contact number 2 Relationship to child 2 Additional information Ethnicity Ethnicity Asian/Asian British – Other Black/Asian/Caribbean/Black British African Black/Asian/Caribbean/Black British – Other Mixed/multiple ethnic groups White and Asian Mixed/multiple ethnic groups White and Black African Mixed/multiple ethnic groups White and Black Caribbean Mixed/multiple ethnic groups – Other White – Welsh/English/Scottish/Northern Irish/British White – Irish White – Gypsy, Roma or Irish Traveller White – Eastern European White – Other Other Ethnic group – Arab Any other Ethnic Group Disability Medical notes Behavioural information Special educational needs Dietary requirements Dietary requirements No meat Vegetarian Diary free Egg free Wheat free Gluten free Halal Kosher Vegan No pork Please tell us about any other dietry requirements Tick boxes - all mandatory Tick boxes - all mandatory I consent to photos being taken of my child and used on the FTLOS Birmingham website (Spectrum Stars Mother company), social media plate forms and shared with School I consent to Spectrum Stars Club sharing and seeking information with my childs school for the purposes of enhancing my childs experience whilst at the club I give medical consent in the case of an emergency I agree to collecting my child/ children on time each day By providing my e-mail address I agree to subscription to the Spectrum Stars News Letter. You will be notified by E-mail if your child is successful in gaining a place with our spring club by April 6th. Please be sure to check your spam folder. 12 + 15 = Submit
