Active Youth Holiday Club Easter 2025

Please only use this booking form if you are paying for your place, if you receive free school meals, you are eligible for a free place through the HAF programme and can book your place at www.itsaboutmederbyshire.co.uk. You will need your FSM code from your school to book your free place.

This holiday club is for young people age 10-16 only.

Name of child*

First NameLast Name

Birth Date*

MonthDayYear

Gender*

MaleFemaleOther

Address*

Street Address

Street Address Line 2

CityCounty

Post Code

Parent/Guardian Information

Name*

First NameLast Name

Contact Number*

Area CodePhone Number

E-mail*

example@example.com

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

Alternative Phone Number*

Area CodePhone Number

Does the participant have any allergies, chronic illness, medical conditions, or special requirements? If yes, please describe. If you would like to talk to a member of staff in more detail, please let us know and we would be more than happy to give you a call to discuss.

From time to time, Insight Community Project uses photo's and video's of our sessions to promote, celebrate and report on our projects. Photo's and videos taken at our sessions will only be used for this purpose.*

I consent to my child being in photos and videos for the above use.I do not consent to my child being in photos and videos.

In the unlikely event of an injury or illness during the session, Insight Community Project staff will administer first aid where necessary. If further treatment or medical attention is required, we will call your emergency contact. If for any reason, we are unable to reach this person, and medical attention is deemed urgent, we will contact the appropriate medical service, including 999. Please also note that staff are unable to administer medication during the sessions and any medication that a child needs to take during the session must be discussed and a care plan completed by parents before taking part.*

I understand the above and consent to my child receiving first aid and further medical treatment, where necessary.

Please select all dates that you wish to book for the Long Eaton Youth Club.

Monday 14th April 10-2pm - Long Eaton Youth ClubTuesday 15th April 10-2pm - Long Eaton Youth ClubWednesday 16th April 10-2pm- Long Eaton Youth Club

Is your child being collected at the end of the session?

Yes, my child will be collected from the session at 2pm (time TBC for Shrek trip).No, my child will be leaving the session by themself and has my permission to do so. I understand that Insight Community Project take no responsibility for the safety of my child once they have left the session. (All children must be collected from The Shrek musical trip for safety reasons.)

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Session information

Sessions start at 10am and finish at 2pm. Children arriving before this time will not be supervised by Insight staff.

Once we have received your booking form, we will send you an email to the address you have provided, which includes a link to make payment via SUM-UP. Please allow 48 hours for your link to arrive. Your space is confirmed upon completing this form unless you are informed otherwise. If your booking is for the next day, please attend as usual even if you have not yet received your payment link.

Unfortunately, we are unable to refund spaces once they have been paid for, if you need to change the date of your booking, we will try our best to fit you in another session where there is space available.

THURSDAY 17th APRIL - TRIP TO TRENT COLLEGE TO SEE SHREK THE MUSICAL!!

We are fortunate to be able to enjoy a special trip to see Shrek the musical at Trent College. If you are booking your child on this trip, please read the following.

There will be no day time session on Thursday 17th April.

The meeting place for this session will be Insight Dance & Arts Studios, 2 Leopold Street, Long Eaton, NG104QD at 5.30pm.

Children will be provided with a packed lunch to eat at the studios before we leave for the show.

We will walk to Trent College as a group.

Parents are expected to collect their child from Trent College at the end of the show at approximately 9pm. (Exact time TBC)

You must provide a contact number on your booking form that will be available to answer during the trip.

IF YOU ARE ELIGIBLE FOR FREE SCHOOL MEALS, PLEASE BOOK FOR FREE VIA www.itsaboutmederbyshire.co.uk. YOU WILL NEED YOUR FREE SCHOOL MEALS HAF CODE FROM YOUR SCHOOL IN ORDER TO BOOK.

If you have any questions, please feel free to email us at insightcic@outlook.com

Many thanks,

Team Insight

Date

Signature

Insight Community Project's Active Youth Holiday Club 2025

Young Persons Information