CKS COMMUNITY CENTRE SUMMER SCHEME

CKS COMMUNITY CENTRE SUMMER SCHEME

19July–13 August 2021
Monday to Friday 9.30am - 11.30am (5 - 8 years)

12.30pm - 2.30pm ( 9 - 12 years)

Games; Sports;

Arts & Crafts

Application Form

Enrolment Fee per week: - £10 per person
Section 1

Summer Scheme Selection
Week choice
Week 1 - 19th - 23rd July
Week 2 - 26th - 30th July
Week 3 - 2nd - 6th August
Week 4 - 9th - 13th August
Section 2

Applicant Information (Attendee Information)
Childs Name

First NameLast Name
Parent/Guardian Name

First NameLast Name
Address

Street Address

Townland

CityCounty

Postcode
Phone Number

Area CodePhone Number
Mobile Number

+44Phone Number
Email

Confirmation Emailexample@example.com
Date Of Birth*

DayMonthYear
Age (at time of application)
Emergency Contact Details
Please indicate if there is any additional support that your child requires whilst attending Summer Scheme ... (For example medical/ health needs, dietary requirements or access requirements).
Section 3

Permission slip for the duration of the summer scheme
YesNo
Section 4

Collection of Children From Summer Scheme - Please indicate approved procedure
YesNo
Please State name of person/persons responsible for collecting
YesNo
Section 5

Photo Permission
Yes (I give Permission)No (I do not give Permission)
Section 6

Signature
This form must be completed and submitted by a parent / guardian / carer. Please complete electronic signature below prior to submission which confirms that the information provided is accurate and correct

Clear
Date

MonthDayYear
Section 7

Payment
Payment Choice
prevnext( X )
1 Week - CKS SUMMER SCHEME
£10.00



2 Weeks - CKS SUMMER SCHEME
£10.00



3 Weeks - CKS SUMMER SCHEME
£10.00



4 Weeks - CKS SUMMER SCHEME
£10.00



Total

£0.00
Please pay on the first morning of the summer scheme at your chosen location.
Section 8

Data Protection
In accordance with the Data Protection Act (as amended from time to time), Fermanagh and Omagh District Council has a duty to protect any information we hold on you. The information you provide on this form will only be used for the purpose of the Summer Scheme and will not be shared with any third party unless law or regulation compels such a disclosure. For further information on how we hold your information please visit the Privacy section at www.fermanaghomagh.com
Should be Empty:

CKS COMMUNITY CENTRE SUMMER SCHEME

Section 1

Section 2

Section 3

Section 4

Section 5

Section 6

Section 7

Section 8