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.
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
Fashion Week- WC 26th July
Yorkshire Week- WC- 2nd August
Extreme locations Week- WC- 9th August
Harry Potter Week- WC 16th August
Space Week- WC 23rd August
Inventor Week- WC 30th August
Monday
Tuesday
Wednesday
Thursday
Friday
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 *
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. *
Required
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