October Holiday Programme 2020

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please only fill this booking form out after having checked availability with the bookings team! Please complete this form for each child if booking more than one.

Parent/ Guardian Name *

Email *

Telephone Number (Landline or Mobile) *

Emergency Contact Number

Child's Name *

Child's Date of Birth *

YYYY

Please select the days you would like to book - £33 per day

Group - 5-11yrs

Monday 12th

Additional Support Requirements

If your child needs a little extra help during their visit, please let us know below so we can best support them.

Medical/Allergy/Dietary Requirements

Please let us know if your child has any allergies or medical conditions that we should be aware of.

Designated Pick-Up

If anyone other than the parent/guardian at the top of the consent form may pick up or drop off your child (grandparent, spouse, friends mum etc), please let us know. We will only let children go with authorised people.

Any other info/details you feel relevant

If you have any additional information or requests for your booking, please add them below.

Payment

Payment is required upon booking - please pay either by bank transfer using the details below or by sending cash or cheque payable to 'Wiston Lodge'.

Bank: Royal Bank of Scotland
Account No: 00274404
Sort Code: 83-16-11
Payment Reference: Surname/OHP

Consent Form

Once you have booked, we will email you confirmation along with our consent form which we need completed, signed by a parent/guardian and brought along on the day.

I agree to the following: *

By submitting this form, I agree to pay for my child's place on the holiday programme within 1 week of booking.

I agree to Wiston Lodge storing my data, only for use on the Holiday Programme.

Required

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms