EASTER Holiday Play Scheme 2024
By registering your child to attend our holiday playscheme you (parent or guardian) agree they may participate in activities delivered by Start It Right cic.
Young person:
Please note: your child must be ages 8-12 to register
Young Person's Name
*
First Name
Last Name
Preferred Name:
Gender
*
Please Select
Male
Female
Other
Prefer not to say
Date of Birth:
*
-
Day
-
Month
Year
Date
Ethnicity
*
Please Select
White British
White Irish
White - Gypsy/ Irish Traveller
White - Other white background
Mixed - White and Black African
Mixed - White and Black Caribbean
Mixed - White and Asian
Mixed - Other mixed background
Asian or Asian British - Indian
Asian or Asian British - Pakistani
Asian or Asian British - Bangladeshi
Asian or Asian British - Other Asian Background
Black or Black British - African
Black or Black British - Caribbean
Black or Black British - Other Black Background
Arab
Chinese
Other Ethnic group
I don't Know
Prefer not to say
Name of school:
*
Address
*
First line of Address
Second line of Address
Town/City
Borough
Postcode
Does your child have a disability and/or additional needs?
*
Please Select
Yes
No
I don't Know
Please provide further information in the box below:
Does your child have a medical condition/allergy?
*
Please Select
Yes
No
I don't know
Please provide further information in the box below:
Registered for Free School Meals
Please Select
Yes
No
Prefer not to say
Low income
Membership Photo
Please provide a clear headshot that does not include any other people. This photo is only used to identify you when attending our youth provision and will not be used for marketing or publicity purposes.
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Emergency Contact Details
Emergency Contact Name
*
First Name
Last Name
Relationship
*
Address (Only fil in if different to the above)
First line of address
Second line of address
Town/City
Borough
Postcode
Main Contact Number
*
Please enter a valid phone number.
Email
*
example@example.com
Additional Emergency Contact Details
Additional Contact Name
*
First Name
Last Name
Relationship
*
Address (if different to the one above)
First line of address
Second line of address
Town/City
Borough
Postcode
Additional Contact Number
*
Please enter a valid phone number.
Additional Email
*
example@example.com
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Holiday Playscheme
Our holiday playscheme will take place from Monday 1st - Friday 12th April from 10 am - 3 pm
April 2024
Please see dates currently available - select date(s) your child will be attending:
Week 1
Tues 2nd
Wed 3rd
Thurs 4th
Fri 5th
Sub total Week 1
Calculation Week 1
Number of days
Your Personal Data
By signing up as a service user, you agree to provide Start It Right cic with certain personal information, which we will process in accordance with all applicable data protection laws. We will also communicate with you about our services and your membership. You can opt out at any time by contacting us: support@startitright.org
Marketing and Publicity
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Payment
Total to pay:
Payment declared:
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