Holiday Club sign up sheet
Thank you for your interest in the holiday club. Please complete the sign up sheet below. This form will automatically sent to Disability Action Yorkshire. We will then get back in touch with you with more details.
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Full Name *
Home address *
Mode of transport- e.g. personal car, taxi (This helps us with dismissal), Thank you. *
Contact Telephone Number *
Dates you would like to attend
Column 1
Monday 13th February
Tuesday 14th February
Wednesday 15th February
Thursday 16th February
Friday 17th February
Please include any details of medical requirements (if applicable) *
Please include any dietary requirements (if applicable) *
Support needs (if applicable) e.g. access, 1:1 assistance *
We also plan trips and visits around Harrogate- such as trips to the cinema. Please let us know if you have a bus pass, are happy for the learner you support travelling on public transport. (We will send out additional consent forms for any off site visits) * Additional costs may apply
Allergies and Food Intolerances. (Please specify if this is only if eaten, in contact with skin or in the same room as) *
Guardian or Emergency Contact Name *
Guardian or Emergency Contact Number *
Guardian email address *
Other information you feel is important to us: e.g. light sensitivity, noise sensitivity, routines etc *
Photo permissions. Please check what applies, thank you. *
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