Parkgate Infants & Nursery Wednesday Dynamo Kwik Cricket Booking Form (Autumn Term 1

Please complete the booking form below to secure your child's place for this Xtra Time After School Sports Club.
Finish Time:*

I would like to book Dynamo Cricket (Wednesdays)
Every Wednesday from 13th November - 18th December (6 weeks)

Open to boys & girls from Reception to Year 2

ONLY 32 SPACES AVAILABLE

*Prizes, trophies, medals, and certificate to be won*

£32.00 (this session runs from 3.15pm - 4.15pm)

Please note: The coaches will always aim to be at the school 15 minutes before every session starts. Our session are on the school site. Registers are emailed to the school office which are then passed on to your child's teachers.

Late booking fee: Great News! There is no £5 late booking fee for this half term.
Child's Full Name:*

First NameLast Name
Child's School:
Child's Year:*
Child's Class:*
Medical Condition(s):*
EpiPen.
It has been advised by our First Aid Trainers that we should administer a second dose of EpiPen 5-15 minutes after the first dose if the child does not feel better. It also allows critical time for the ambulance crew to get to the session. If your child requires an EpiPen, your child must have TWO EpiPen's with them at all times. By ticking this box you are confirming that you will send your child in with two EpiPen's. Failure to do so will result in Xtra Time sending your child to the school office. Your child will not be able attend the session until they have two EpiPens. This is to safeguard your child and Xtra Time Kidz Club Staff.*

I confirm that I have read and understand the above.
Does Your Child Have Any SEN:*
Does your child have any SEN (Special Educational Needs)?
Details of Medical Condition(s) / SEN:*
Please provide details of any medical conditions.and/or Special Additional Needs. For example:Asthma and/or ASD etc
Parent/Guardian Name:*

First NameLast Name
Parent/Guardian E-mail:*
example@example.com
Emergency Contact 1:*
Mobile number
Emergency Contact 2:*
Mobile number
Full Address:*

Street Address

Street Address Line 2

CityCounty

Postcode
Collected By:*
Name of person collecting your child
Relationship To Child:*
What is their relationship to your child
Security Code:*
Choose a security code of your choice that'll be used if somebody else collects your child
Sub Total £
Late booking fee

Applied £5.00
Late Booking Fee £
Late booking fee applied after deadline
Grand Total:
Payment Method:*

Bank Transfer - Please follow the instructions belowChildcare vouchers (please select your provider below)
Childcare Provider:*

CO OP - 85116843EDEN RED - P20733006KIDDIVOUCHERS - 100418CARE4 - 18475662BUSYBEES - XTRA TIME KIDZ CLUB - HolywellCOMPUTERSHARE - 0020197568RG CHILDCARE - 97926708410FIDELITI - XTR001CFAIRCARE - XTHO0218TAX FREE CHILDCARE SCHEME - Holywell Ofsted No: EY444153ENJOY BENEFITS - WD18 9QDSODEXO - 850954OTHER - Please provide details in additional comments box below
Please make your booking payment in full to the account below:

It is soley the parent/carers responsibilty to make the booking payment in full. If your child's payment has not been made in full to the account specified above, we cannot secure your child's booking.

Once you have made your payment in full, please include your payment reference and payment date below.
ALL PAYMENTS MUST ONLY BE PAID INTO THE ACCOUNTS LISTED ABOVE AS EACH XTRA TIME SERVICE HAS ITS OWN SPECIFIED ACCOUNT. THIS HELPS US TO ALLOCATE YOUR PAYMENT. IF YOUR PAYING BY CHILDCARE VOUCHERS AND YOUR PROVIDER IS NOT LISTED ABOVE PLEASE CONTACT US.
Payment Reference:*
Payment Reference
Payment Date:*

DayMonthYear
Date
Please attach a screenshot of your payment below.*

If you are unable to attach a screenshot of your payment, please write the details of your payment on a piece of paper stating the reference, date and amount paid. Providing this enables our finance team to easily find your payment and avoid the need to contact you. Please do not contact us to confirm if your payment has been made. We will contact you if there are any issues with your payment. Your submission of this form and confirmation email is confirmation of your booking.
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CHILDCARE VOUCHER PAYMENTS MUST BE PAID IN FULL ON THE DATE YOUR BOOKING FORM IS SUBMITTED. THE EXACT PAYMENT AMOUNT ON YOUR BOOKING FORM MUST BE MADE IN FULL, USING THE REFERENCE BELOW. IF THIS PROCESS IS NOT FOLLOWED YOU WILL NOT HAVE SECURED YOUR CHILD'S BOOKING, AND YOUR CHILD WILL NOT BE ABLE TO ATTEND THE CLUB.
Additional Comments:
Any additional information that will help us understand your child's needs better
Do you give consent to Xtra Time Kidz Club to take pictures or videos of your child which will ONLY be used for marketing purposes (Social media platforms, www.xtratime.co.uk, flyers and other advertising purposes)?*

YesNo
Do you follow us on social media?*

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Thank you for following us on social media.
Please Like, Share and Subscribe to our social media platforms by clicking on to the images below.
Community Give Back

If you are in need of further support, please fill out our enquiry form here and a member of our team will be in contact with you to see how we can assist. All throughout the year, Xtra Time strives to help as many families in the local community as possible, and in particular we have a big push for the Christmas period. In the past we have helped over 300 families by providing food, amenities and toiletries and every year, we want to be able to provide even further support
Did you know we do Birthday Parties?

Is your child's birthday within the next 3 months? We are offering an exclusive £25 off Birthday Party Bookings to all existing customers. Visit our Birthday Party Form by clicking here and a member of our team will be in touch with you.
Did you know we do Private One-to-One / Group Tuition?

Would you be interested in a variety of Private One-to-One / Group Tuition for you or your child? Focusing on upskilling, mental health, well being, weight loss, confidence and more. Visit our Private 1-to-1 / Group Tuition Booking Form by clicking here and a member of our team will be in touch with you.
How Did You Hear About Us?*

Email / Text / WhatsAppHoliday Camp FlyerMy Child's SchoolFamily / FriendsSearch EngineSocial MediaOther
Other: How Did You Hear About Us:*
Other way you heard about us:
In the case of poor weather, coaches will take the children indoors to do sports if there is sufficient space or alternatively we will do a sports related quiz with the children in a classroom. Please rest assured that to make up for lost playing time, the following week we will minimise the skill work and we will go straight in to matches. Please note this is a rare occurrence.*

I have read and understood this
To keep up to date with important news, alerts, updates and exciting events - please save the office contact number to your contacts as part of completing your booking form. 07746 945 903.*

I have read and understood this
Please make a note of the below dates or refer to your booking confirmation as a reference. Start of sessions every Tuesday from 13th September - 18th December (Last Session of the half term/term).*

I have read and understood this
Please sign below to confirm your booking.
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EpiPen.