Little Gemz ltd

Name of child

Date of birth of child

Days and hours required

Monday's

Hours required

Tuesday's

Hours required

Wednesday's

Hours required

Thursday's

Hours required

Friday's

Hours required

Funding

15 hours 3-4 funding
30 hours 3-4 funding
2 year funding
No funding

Date you would like your child to start

Will you require:

All year round
term time only
holiday club only

your name

Email address