February Half Term Briscoe Community Holiday Club

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

**Please Complete a separate form for each child attending**

An Essex ActivAte club that it is being funded by Active Essex, Essex County Council and the Department for Education. Holiday lunch club with hot/cold food option

Felmores End Pitsea, Basildon SS13 1PN

Holiday Club times Monday 19th Feb 9am-1pm Tuesday 20th Feb 9am-1pm Wednesday 21st Feb 9am-1pm

A glimpse at the fun you can have at our club

Name Of Child *

Childs Age

What Days will you be attending the club *

Monday 19th February 9am -1pm

Tuesday 20th February 9am - 1pm

Wednesday 21st February 9am - 1pm

Required

Any Medical or any other issues we need to be aware of? *

Address *

Emergency Contact Number *

Email Address *

Dietary Requirements *

Vegetarian

Vegan

Kosher

Halal

Gluten-free

None

Other:

Permission for photos to be used on social media *

Yes

Would you be interested in attending other ATF activities

Yes

Clear selection

What activities would your child most be interested in

How did you hear about this event?

Website

Friend

Newsletter

Clear selection

From previous attendance How has the club benefited your child? *

Improved confidence

Improved skills

Improved behaviour

Increased friendships

Other:

Required

I confirm that I am eligible for a free space on the Essex ActivAte programme because:

My child is eligible for benefits based free school meals

We are a working family who is struggling financially and would benefit from this holiday club support

We are not eligible but our child will be bringing their own packed lunch

Clear selection

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms