Active Youth HAF Club Easter Long Eaton 2026

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

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

Monday 30th MarchTuesday 31st MarchWednesday 1st AprilThursday 2nd April

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.

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, trained 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.

Yes, my child will be collected from the session at 2pm.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.

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

Once we have received your booking form, we will send you an email to the address you have provided, which includes our bank details in order to make payment. 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.

PLEASE NOTE

Our Easter HAF club has moved to a new venue at DDS Studios, West Mills, 2 Leopold Street, Long Eaton, NG104QD.

There are no facilities to leave bikes or scooters during the session so please do not bring them to the club.

Sessions start at 10am and finish at 2pm. Children arriving before this time will not be supervised by Insight staff. We are located on the third floor of turret C, please take care on the steps when arriving or leaving the session.

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.

The information provided in this form will be processed and stored in line with our data protection policy which can be found on our website at www.insightcommunityproject.co.uk.

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

Many thanks,

Team Insight

Date

Signature

LONG EATON Active Youth HAF club - Easter 2026

Young Persons Information