Creative Minds Holiday Club Booking 1st June

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Essential Information Form

Child's full name *

Date of birth *

YYYY

Age *

School year group (current) *

Reception (age 5)

Year 1

Year 2

Year 3

Year 4

Year 5

Year 6

Which day(s) would you like to book? (This is not confirmation. We will confirm with an email). (£20 per day). *

Wednesday 1st June

Required

Do you require Breakfast Club (8am - 9am)? (£2 per session) *

Yes

Parent/guardian name(s) *

Address *

Contact 1: Name, relationship to child and telephone number. *

Contact 2: Name, relationship to child and telephone number. *

Is there anybody who may not legally have contact with your child? Name and address.

Dietary requirements *

Medical information: Drs name, surgery and contact number *

Please give us any information of allergies (including food). *

Please give information on any special needs or disabilities. *

Please give all information about any medical conditions e.g. Epilepsy, Diabetes, asthma etc *

Please sign here in acceptance for us to administer first aid or take to hospital in the event of an accident. *

Do you give permission for photos of your child to be taken and used on social media for promotional material? *

I give permission.

I do not give permission.

How did you hear about us? *

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