HSGA Playscheme Application Form 2019
Venue: Fixby J & I school, Lightridge Road, Fixby, Huddersfield. HD2 2HB
Huddersfield Support Group for Autism
Child's date of birth
Child's full address (inc postcode)
Parent / carer contact number (home and mobile)
Alternative emergency contact (name, relationship, phone number)
Do you have social worker involvement? If so, please provide a name and contact number.
Select age appropriate week
Week 1- 29/07/19 (ages 3 - 8)
Week 2 - 05/08/19 (ages 9 - 13 )
Week 3 - 12/08/19 (ages 14 - 17)
Unable to attend the appropriate week, please look at other options
Does your child need transport? (Charge of £10 per day, to be paid in advance)
Do you consent to your child
Receiving emergency medical treatment
Going on organised outings
Having suncream applied
Videos and photos for funding use only (really important, not released to the public)
Photos for social media
Photos for home diaries
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service