Apex Easter Holiday Club April 2024 - Admissions Form
Dear Parent/Carer,

The Apex Holiday Club will be delivered at Daubeney Primary School during the Easter Holidays.  The Holiday Club is open to all young people from any school. Ages 5-16.

The programme will run on:

Tuesday 2nd to Friday 5th April 2024.
Timings - 12pm to 4pm - each day.

In order to best prepare for the club, please complete the form below so that we can plan for the number of pupils that we need to cater for.  Please complete a separate form for each child.

Cost - Pupils who are on Free School Meals - No Charge (FREE); or then £35 per day.

Once you have completed the form, Apex will confirm your space (subject to availability) - Please send any further/additional information required from within the form to info@alh.org.uk.  Without this information, we will not be able to confirm your space

Trips will be arranged separately

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Pupil First Name *
Pupil Surname *
Pupil Year of Birth *
Pupil Month of Birth *
Pupil Day of Birth *
Name of school currently attending? *
Other - Name of School
Pupil Year Group *
Pupil Gender *
Pupil Ethnicity *
My child is eligible for Free School Meals (FSM) *
Free School Meals eligibility is means-tested and for families on low income.  If your child received FSM before government changes, please choose 'Yes'.  Checks will be made on the Hackney Council Free School Meals eligibility database
I'm applying for a FSM place or a Paid place *
My child has an Education & Health Care Plan (EHCP) *
If you have an EHCP, please email it to info@alh.org.uk or contact us on 020 8432 6699 to discuss further.
Food Alergies *
Medical Condition *
Special Needs *
If yes, please provide further information by email on info@alh.org.uk or contact us on 020 8432 6699 to discuss further
My child requires & receives additional/1-2-1 support at school. *
If yes, please provide further information by email on info@alh.org.uk or contact us on 020 8432 6699 to discuss further
Parent Full Name *
Parent Email *
Parent Mobile Number *
Address 1 *
Address 2 *
Post Code *
Next of Kin Contact Name (for emergencies - not parent) *
Next of Kin Contact Number *
Parent/Guardian Declaration:  I confirm that the information provided above is correct to the best of my knowledge. I also confirm that I have read, understood and accept the terms and conditions for Apex. *
Apex Holiday Club Cycle Training Consent Section:

TERMS AND CONDITIONS FOR CYCLE TRAINING (please read carefully)
1. The rider (or Parent/ guardian) signed up for cycle training has read, understood and agrees to these terms and conditions to take part in cycle training
2. Riders under the age of 16 MUST wear an approved cycle helmet while training. A limited number may be available. Please provide one if you can.
3. Learn to Ride sessions and Level 1 training takes place in an off the road environment.
4. Training will cover all aspects of safer cycling including recommended procedure for starting, stopping, turning left and right.
5. Instructor(s) can adjust the rider’s cycle if necessary.
6. The rider will conduct themselves in an appropriate manner and follow the directions of the instructor(s). The instructor may decline training for a rider
whose behaviour is disruptive or is considered to be putting themselves, other people or property at risk.
7. The rider will be suitably dressed for cycling.
8. Any personal belongings brought to the course is done so at the rider’s own risk.
9. Cycle Confident Ltd is not responsible for any injury or loss or damage to any person or property not caused by an instructor’s negligence.
If you give your consent for your child to take part please click 'I agree' below.
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