Holiday Activity Booking Form
which age group do you wish to book
*
8-12 (10 - 2pm)
12+ (3-7pm)
Which Venue would you like to book (Drop off addresses at bottom of form)
*
Windybank liversedge
Childs name
*
First Name
Last Name
Childs Preferred Name
First Name
Last Name
Date Of Birth
*
-
Month
-
Day
Year
Date
Childs Gender
*
Male
Female
I consent to (named child) being filmed and photographed for the Holiday Activity Fund promotional film. The footage or pictures may be used for evidencing the positive outcomes of the programme to the Department for Education, on Kirklees Council internal and external websites and in staff training events. Children and young people will not be named in the videos. Footage or photos may be of groups/at a distance or of young people speaking directly to the camera.
*
Yes
No
Back
Next
Email Address
*
Parents / Guardian Name
*
First Name
Last Name
Phone Number
*
Emergency Phone number
*
House Number
*
Post Code
*
Which school does your child attend
*
These sessions are free if you child is on free school meals, SEND,SGO or CAO
*
Free school meals
SEND
SGO/CAO
Not Eligible (A £10 Per day charge will apply)
Book dates at Crownest Adventure Park
29 July
30 July
31 July
1 August
5 August
6 August
7 august
8 August
12 August
13 August
14 August
15 August
19 August
20 August
21 August
22 August
Any SEN /Disability /allergies/ dietary needs
*
yes
no
If yes please give details
please drop off and collect from
Windybank Community Centre
Central Avenue
Liversedge
WF158LE
Submit
Should be Empty: