Holiday Club 'Xpress, February 2019
All subsidised places have now been taken. If you would like to register your child for the February Half term club please fill in the form and pay by Bacs, cheque or cash. Charges: £30 for children on free school meals, £40 for all other children.
Email address *
Childs Name *
Your answer
Address *
Your answer
Post Code *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
School *
Your answer
School Year *
Your answer
Parents Mobile *
Your answer
Name and contact details of parent/carer and one other person we can contact in case of emergency. The named persons can also collect the child *
Your answer
Doctors name and telephone number *
Your answer
Does your child have any medical complaints/allergies/special needs? If yes please specify. *
Your answer
What is the ethnicity of your child? *
What is the faith background of youth child *
*
Yes
No
Does your child receive free school meals?
Does your child speak English as an additional language (EAL registered)?
Does your childe have Special Educational needs (SEN registered)?
Does your child have a statement of Special Educational needs?
Does your child have a disability
I will allow my child/children to participate in any photographs which may be circulated in promotional advertising, local newspapers or childcare magazines.
Once you have read our terms and condition at the bottom of the page please type your name below to confirm. *
Your answer
Payment - You will get a confirmation text or email one payment is received
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service