Moretonhampstead Holiday Activity Club
Booking Form for Easter 2008
The Club runs 9am-4pm and dates are below. The venue is the "The Yard", The Old School, Fore St, Moretonhampstead TQ13 8LL. Tel: 01647 440583 / 07792422608
The cost is £10 per child per day or £5.50p per half day.
Please enclose your payment to: Moretonhampstead Kidz Klub indicating the days your child is attending and return to:
Katheryn Hope, MAY Coordinator, The Old School
Places limited. Payment must
be made in advance.
Bookings
will be taken on a first come first served basis.
..."
To be filled out
in full by parent or guardian:
Childs Name
..(1 form per child please/photocopy as necessary)
Address:
.......................................................
Postcode
.
Age
..
..D.O.B
.(Please supply)
Name of Guardian/Parent
................Tel No:
Emergency Contact Name
Tel No:
Any Medical conditions/Allergies Yes□ No□ (Please tick)
If Yes, give details
....................
Doctors Name Tel No: .
Any Special
needs? Yes□ No□ (Please tick)
If Yes, give details
Childs Key worker
Tel No:
.
Who will collect your child?..............................................................................................................
Are you happy for your child to walk home? Yes□ No□ (Please tick)
Do you give permission for staff t give medical
treatment in an emergency? Yes□ No□ (Tick)
Do you give us permission to use face paints on
your child Yes□ No□ (Please tick)
Do you give permission for us to take photographs? Yes□ No□ (Please tick)
Do you give permission for us to go to the Sentry Play Area? Yes□ No□ (Please tick)
Signature ..Date .
Dates
you are booking (Please tick)
| Week 7th April |
9am-4pm |
9am-12.30 |
12.30-4pm |
| Mon |
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| Tues |
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| Thurs |
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| Fri |
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| Week 14th April |
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| Mon | |||
| Tues |
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| Thurs |
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| Fri |
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Fees £10 per day or £5.50p per half day per child .
A cheque must be enclosed with booking. Thank you.
Cheque enclosed
for
...(amount)
Signature & Relationship . .................
Return to:
(Please note: The Club is highly subsidised through grants & we must reserve the right
to change the days we run
or cancel the scheme at short notice if funding is not successful. In this event
all payments will be refunded. If, however, your child does not attend on a
booked day the fee is non-refundable.)