Easter Holiday Club 24
In completing this registration form, you give permission for the following student to attend and take part in activities led as part of our Easter Holiday Club. Please ensure this form is filled in accurately as details on the form will be used for correspondence and for contact in case of emergency.
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Student's full name: *
Students DOB: *
Nursery/ School currently attended:  *
School Year  *
Sessions attending:  *
Required
Students address (including post code): *
Emergency contact 1 name:  *
Emergency contact 1 telephone: *
Emergency contact 1 address (including post code) (If different from student)
Emergency contact 2 name:  *
Emergency contact 2 telephone: *
Emergency contact 2 address (including post code) (If different to student)
Parent / Carer name:  *
Parent/ Carer email address (all correspondence will be sent to this email address):  *
I am happy to receive all correspondence by email:  *
Details of any medical condition (eg asthma, diabetes, epilepsy, allergies, disability, special educational needs (SEN) or mental ill health concerns). Please state 'none' if not applicable.
 *
Please give details of any special dietary requirements, including food allergies / intolerance. Please state 'none' if not applicable.
 *
Permission to take the children off site. We are planning on using the field across the road at break times (Weather permitting). Please indicate your consent below: 
 *
Permission to perform first aid - Should it be required, we need permission to administer first aid on the named student. This will always be performed by our qualified first aider. Please indicate your consent below.
 *
Photograph/ Video Opt Out - We will be taking photographs and videos of the students during holiday club. Some of these photographs may be used on our Website/ Facebook / Instagram pages and/or in print for publicity purposes. If you DO NOT wish for your child's image to be displayed, please indicate below.
 *
Where did you hear about Easter Holiday Club? *
I agree to make the payment of the deposit on the day of booking,  please note, if deposit is not paid, your child's place can not be held. I will bring the balance up to date in full on/before 3rd April, in order for the above student to take place in Easter Holiday Club. I understand that all payments made are non-refundable and days can not be changed unless there are exceptional circumstances, which must be requested and agreed in writing via email.  *
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