Children's Holiday Club Registration Form
Please fill out the form to register your child for the holiday club. (Only 10 places available so it will be first come, first served).
Child's Full Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Childs Gender
Male
Female
Parent/Guardian's Full Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Phone Number
-
Area Code
Phone Number
Email Address
example@example.com
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
-
Area Code
Phone Number
Does your child have any allergies or medical conditions? Please also let us know if your child suffers with anxiety/confidence issues.
Which school does your child attend?
Please select which days you prefer your child to attend. All session times are 10:30am-2:30pm Venue - St Pauls Church, 57 Dewsbury Road, Cleckheaton, BD19 5BT (Please note we cannot guarantee all the dates you select due to the limited number of places, but will send you a confirmation email with the dates allocated)
Mon 3rd Aug
Tue 4th Aug
Thurs 6th Aug
Fri 7th Aug
Mon 10th Aug
Tue 11th Aug
Thurs 13th Aug
Fri 14th Aug
Mon 17th Aug
Tue 18th Aug
Thurs 20th Aug
Fri 21st Aug
Mon 24th Aug
Fri 28th Aug
Is your child entitled to free school meals?
Yes
No
I consent to my child being filmed and photographed during the holiday club activities. This may be used for evidencing positive outcomes of the holiday club to enable us to get more funding for future clubs. It may also be used on our social media page, Sensory Play UK.
Yes
No
Submit
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