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Holiday Play Scheme May 2024
Applications for the Chestnuts Holiday Playscheme
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* Indicates required question
Child's Full Name
*
Your answer
Current School Year
*
Choose
Reception
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
Does your child attend Chestnuts Primary School? If no, which school do they attend?
*
Yes
Other:
Your E-Mail address
*
Your answer
Parent/Carer Name:
*
Your answer
Home Address
*
Your answer
Mobile Number
*
Your answer
Relationship with child
*
Your answer
Emergency contact 1 name
*
Your answer
Emergency contact 1 phone number
*
Your answer
Emergency contact 2 name
*
Your answer
Emergency contact 2 phone number
*
Your answer
Any known allergies and information of any treatment that may be required
*
Your answer
Specific dietary requirements
*
Vegetarian
Vegan
Kosher
Halal
Gluten-free
None
Other:
Any known medical conditions
*
Your answer
Do you give permission for first aid to be administered and medical assistance sought if required?
*
Yes
No
Days Required
*
Tuesday 28/05
Wednesday 29/05
Thursday 30/05
Friday 31/05
Required
Any other comments
Your answer
Do you agree that you understand that your child's place could be removed if fees are not paid on time and that there will be no refunds if your child does not attend a pre-booked day?
*
Agree
Disagree
Submit
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