Activate Essex Booking Form summer 2022

Holiday club booking form

Freshwaters Academy ActiVate Essex Summer 2022
Children’s details
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Date of birth
Age
Child’s gender

Male Female Other Prefer not to say
Which school does your child attend?
School address
Doctors details

Please include all details
Doctors Name

First Name Last Name
Surgery address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Doctors phone number
Additional and medical needs
Does your child have any allergies?

Yes No
Please provide details
Does your child have any additional needs?

Yes No
Please provide details
Is there any foods your child cannot eat due to cultural or religious beliefs?

Yes No
Please provide details
Does your child take any regular medication?

Yes No
Please provide details
Medical consent

Please indicate if you are happy for your child to receive emergency medical treatment
I am happy for my child to receive the following treatments:

Simple first aid including but not limited to plasters Emergency medical treatment by ambulance/ medical professional Calpol in the event of fever Blood transfusions (medical professional)
Parents details
Parent 1

First Name Last Name
Phone number
Email
example@example.com
Parent 2

First Name Last Name
Phone number
Email
example@example.com
Emergency contact details

Please provide 2
Emergency contact 1

First Name Last Name
Phone number
Emergency contact 2

First Name Last Name
Phone number
Photographs and social media
Type a question

Photographs for in club use Photographs for social media/advertising Videos for in club use Videos for social media/ advertising Photos and videos to be shared with local authority and DfE All of the above
Dates requested

Paid places only are available for February half term and payment must be made to confirm your place via bank transfer with your child’s name as the reference. Any late collections of children are charged at £1 per minute per child.

Type a question

	HAF funded 10-2	10-2 paid place
25/07
26/07
28/07
29/07
01/08
02/08
04/08
05/08
08/08
09/08
11/08
12/08
15/08
16/08
18/08
19/08

Our fun packed holiday club at Freshwaters academy is running for 4 days per week for 5 weeks this summer holidays! Each day is packed full of fun, games, dance, sports and arts and crafts. Our paid places are limited to 20 per day and our funded places are limited to 30. Please book early to ensure all of the days you need are available.

Each day please ensure children arrive with a refillable water bottle and dressed for active play! Everything else will be provided, ready for fun packed and exciting days!

PLEASE NOTE, ALL FUNDED PLACES ARE ONLY AVAILABLE TO CHILDREN IN RECIEPT OF BENEFITS RELATED FREE SCHOOL MEALS
Holiday club site

Freshwaters Academy, Harlow, CM20 King Harold Academy, Waltham Abbey, EN9
What time of lunch will your child have?

Packed lunch Hot Lunch, provided to all children free of charge
Does your child receive free school meals?

Yes No
HAF booking code number
Any other relevant information?
By signing you are agreeing to our terms and conditions as well as indicating all information included is accurate.

Clear
Should be Empty:

Holiday club booking form

Children’s details

Doctors details

Additional and medical needs

Medical consent

Parents details

Emergency contact details

Photographs and social media

Dates requested