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February 12th Activity Day 2020
Please only fill this booking form out after having checked availability with the bookings team! Please complete this form for each child if booking more than one.
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* Indicates required question
Parent/ Guardian Name
*
Your answer
Email
*
Your answer
Telephone Number (Landline or Mobile)
*
Your answer
Emergency Contact Number
Your answer
Child's Name
*
Your answer
Child's Date of Birth
*
MM
/
DD
/
YYYY
Bumble-Bees (5-7yrs)
Otters (8-12yrs)
Wednesday 12th
Bumble-Bees (5-7yrs)
Otters (8-12yrs)
Wednesday 12th
Total Number of Days
*
Your answer
Breakfast Club / Late Stay Wraparound
*
Wraparound can be booked nearer the time if required but must be booked in advance.
Breakfast Club Only Required - £4 per day
Late Stay Only Required - £4 per day
Both Breakfast Club & Late Stay - £7 per day
Not Required
Other:
Additional Support Requirements
If your child needs a little extra support during their visit, please let us know below so we can best support them.
Your answer
Medical/Allergy/Dietary Requirements
Please let us know if your child has any allergies or medical conditions that we should be aware of.
Your answer
Designated Pick-Up
If anyone other than the parent/guardian at the top of the form may pick up or drop off your child (grandparent, spouse, friends mum etc), please let us know. We will only let children go with authorised people.
Your answer
Any other info/details you feel relevant
If you have any additional information or requests for your booking, please add them below.
Your answer
I agree to the following:
*
By submitting this form, I agree to pay for my child's place on the holiday programme within 2 weeks of receiving the confirmation email.
I agree to Wiston Lodge storing my data, only for use on the Holiday Programme.
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