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October 2021 Holiday Programme
Booking Form
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* Indicates required question
Email
*
Your email
Child's Name:
*
Your answer
Child's Age:
*
5-6
7-8
9-10
11-12
Child #2 Name and Age:
Your answer
Child's #3 Name and Age:
Your answer
Child #4 Name and Age:
Your answer
Parent/Guardian's Name:
*
Your answer
Parent/Guardian's Email:
*
Your answer
Parent/Guardian's Phone Mobile Number and Emergency Contact details if different:
*
Your answer
Which programmes will be attended? (AM 10-12, PM 1.30-3.30, $10 per session)
*
Wed 6th AM PITCH A MINER'S TENT AND BUTTER MAKING
Wed 6th PM MAKE PAINT AND DO ROCK ART
Thurs 7th AM MUSEUM VISIT AND MOBILE MAKING
Thurs 7th PM MAKE LEMONADE AND BUILD A TOWN
Tues 12th AM BLOCK PRINITNG
Tues 12th PM VICTORIAN DRESS-UP AND GAMES
Wed 13th AM MAKE LEMONADE AND BUILD A TOWN
Wed 13th PM PITCH A MINER'S TENT AND BUTTER MAKING
Required
Are there any allergies, health or behavioural issues to be aware of?
N/A
Other:
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Name of Medical Centre child/ren enrolled in:
*
Your answer
I give my permission for my child/ren to be photographed (photos may be used for our Facebook page or marketing)
*
Yes
No
Payment (Confirmation of booking will be sent upon payment received. No refunds will be given unless notice of cancellation is received 48 hours prior)
*
I will pay via Internet Banking to a/c # 02-0948-0017755-00 (child's name as a reference and holiday programme)
I will pay by cash at the Lakes District Museum
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