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Cooks Spinney Primary School Summer 2021 Holiday Course - Booking Form
Please complete the short form to provisionally book your child's(rens) place on the holiday courses taking place at Cooks Spinney Primary School
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* Indicates required question
Parent/Carer Name
*
Your answer
Parent/Carer Email
*
Your answer
Emergency Contact Number 1
*
Your answer
Emergency Contact Number 2
*
Your answer
Child's first and surname
*
Your answer
Child Date of Birth
*
MM
/
DD
/
YYYY
What Primary School does your child attend?
*
Your answer
Child Year Group
*
Choose
Reception
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
Ethnicity (if you are happy to share)
White English/Welsh/Northern Irish/Scottish/British
White Irish
Mixed White and Black Caribbean
Mixed White and Black African
Mixed White and Asian
Asian
Asian British
Black African
Black Caribbean
Black British
Please note any medical conditions
Your answer
Please note any specific dietary requirements or food allergies
Your answer
I can confirm that I am eligible for a free space on the Essex ActivAte summer programme because:
*
My child is eligible for benefits based free school meals
We are a working family who is struggling financially and would benefit from this holiday club support
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