Xtra Time Ad Hoc Booking Form

Xtra Time The New Field Cassiobury

Ad Hoc Booking Form (2025/2026)

Please complete the booking form below to secure your child's place for Xtra Time Breakfast and After School Clubs
Dear Parents and Carers, spaces at Xtra Time The New Field Cassiobury are high in demand. Please could we ask ALL parents/carers to call Momina, your Provision Manager to ensure we can accommodate your booking. Spaces will be offered on a first come first served basis.

Please note: Bookings made without prior approval from Momina may result in your booking being refused. To avoid disappointment, please call 07445 657 526 to confirm availability before submitting your booking form.

We will always try to accommodate your childcare needs, however Xtra Time Kidz Club is very popular. We ask ALL parents to book the half term in advance to secure your child's booking, and to avoid disappointment.

Please note Ad Hoc bookings are subject to availability and are offered at the manager's discretion. To avoid disappointment please contact your provision manager prior to submitting a booking form to confirm availability - 07445 657 526.

* Please note: Ad Hoc bookings that are not accompanied by an annual registration form will not be accepted.
An Ad Hoc booking is a short notice booking for parents who need to add additional days to their original Xtra Time childcare booking at short notice.
Have you completed a registration form?*

Yes - I have completed an annual online registration formNo - Please complete an annual online registration form first
Prior to completing an Ad Hoc booking form you must complete a registration form, if you have not done so already, please click on the link Registration Form.
Which setting would you like to book onto?*
Child's Full Name*

First NameLast Name
Child's School*
Child's Year:*
Child's Class:*
Parent/Guardian Name*

First NameLast Name
Parent/Guardian E-mail*
example@example.com
Emergency Contact 1*
Mobile number
Emergency Contact 2*
Medical Conditions?*
EpiPen.
Further on from our 1st Aid Training in September 2021, it has been advised 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 EpiPen's. This is to safeguard your child and Xtra Time Staff.*

I confirm that I have read and understand the above.
Does Your Child Have Any SEN?*
Details of Medical Condition(s) / SEN:*
The costs for the sessions are as follows:

Breakfast session: £7.50 (this session runs from 7:30am to the start of school)

After School session - 4:30pm Collection: £10.50 (this session runs from the end of school to 4:30pm)

After School session - 6pm Collection: £14.50 (this session runs from the end of school to 6pm)
Ad hoc booking 1
Due to a low number of bookings, we will be resuming our Wrap Around service on 22nd September.
Please note: You must select a date before selecting the session(s) below.
Booking 1 - Date of attendance

DayMonthYear
Booking 1 - Please select the club you require

Breakfast clubAfter School club - 4.30pm CollectionAfter School club - 6pm Collection
Booking 1 Total £
Ad hoc booking 2
Please note: You must select a date before selecting the session(s) below.
Booking 2 - Date of attendance

DayMonthYear
Booking 2 - Please select the club you require

Breakfast clubAfter School club - 4.30pm CollectionAfter School club - 6pm Collection
Booking 2 Total £
Ad hoc booking 3
Please note: You must select a date before selecting the session(s) below.
Booking 3 - Date of attendance

DayMonthYear
Booking 3 - Please select the club you require

Breakfast clubAfter School club - 4.30pm CollectionAfter School club - 6pm Collection
Booking 3 Total £
Ad hoc booking 4
Please note: You must select a date before selecting the session(s) below.
Booking 4 - Date of attendance

DayMonthYear
Booking 4 - Please select the club you require

Breakfast ClubAfter School club - 4.30pm CollectionAfter School club - 6pm Collection
Booking 4 Total £
Grand Total for sessions:
Payment Method:*

Bank Transfer - Please make a bank transfer into bank account belowChild Care Vouchers - Please select your provider below
Childcare Voucher Provider:*

CO OP - 85116843EDEN RED - P20733006KIDDIVOUCHERS - EY444153CARE4 - 18475662BUSYBEES - XTRA TIME KIDZ CLUB - HolywellCOMPUTERSHARE - 0020197568RG CHILDCARE - 97926708410FIDELITI - XTR001CFAIRCARE - XTHO0218TAX FREE CHILDCARE SCHEME - Holywell Ofsted No: EY444153ENJOY BENEFITS - WD18 9QDSODEXO - 850954OTHER - Provide details in additional comments box
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 XTCassiobury - Child's Name. 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.
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 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.
Cancelof
Please continue with your Ad hoc form as you normally would. Once you get to the additional comments section please write that you have made a bank transfer, including your child's name, reference used, payment amount and payment date. We are working very hard towards fixing this issue. We apologise for any inconvenience.
Please Note: You will not get a confirmation message from Xtra Time Kidz Club when you have processed your payment. If there are any issues with the payment, a member of our finance team will get in contact.
Additional comments:
We are offering an exclusive £25 off Birthday Party Bookings to all existing customers, would you like the Xtra Time team to help plan your child's next birthday party? *

YesNo
Do you follow us on social media?

YesNo
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.
By selecting the check box below, you agree to our T&Cs.
I consent to Xtra Time Kidz Club/1st Touch Coaching taking pictures of my child which may be used for marketing purposes (Social media platforms, website, flyers and other advertising purposes only). *

YesNo
I have completed this booking form as honestly and accurately as possible, I understand that Xtra Time Kidz Club/1st Touch Coaching can only provide the best service based upon the information I provide. If my child has any special requirements, for example toileting or SEN. I have added this information in the additional comments section above*

By selecting this box I accept the above
Please sign below to confirm the sessions listed above are the sessions you would like your child to attend.*

By selecting this box and signing below I agree my booking is correct.
Signature:

Clear
Once the submit button has been clicked your booking is being processed, please do not click the submit button more than once otherwise you will create a duplicate booking and get charged twice. Duplicate bookings and payments being charged twice are solely down to the Booker clicking the submit button more than once, all fees incurred for processing a refund will be payable by the person who made the booking. To avoid any inconvenience, please be patient while your booking is being processed.*

By selecting this box I accept the above
Date

DayMonthYear
Date
Should be Empty:

EpiPen.

Ad hoc booking 1

Due to a low number of bookings, we will be resuming our Wrap Around service on 22nd September.

Ad hoc booking 2

Ad hoc booking 3

Ad hoc booking 4