Summer Holiday Activity Form

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This project has been funded by East End Community Foundation and will run for three weeks starting from 23rd July.

Activities will take place between East Ham Library and Renewal Programme.

Please note this programme is for children aged 8-19 years old only.

Child's Information

Please tell us as much information about the child as possible.

First Name and Surname *

Gender *

Female

Male

Other

Date of Birth *

Phone Number *

Home Address and Postcode *

School *

Parent/Carer Information

Guardian Full Name *

Child's Relation to You *

Guardian Contact Details (telephone and e-mail address) *

Additional Information

Please provide further information on the child.

Does the child have any special learning needs/disabilities? (if 'Yes', please specify) *

Do the child have any dietary requirements/allergies? (if 'Yes', please specify) *

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