October Half-Term Holiday Camp
Oasis Academy Short Heath, Streetly Rd, B23 5JP
Young Person's Information:
Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date
Age
*
Gender
*
Please Select
Female
Male
Prefer Not To Say
Ethnicity
*
School
*
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Postcode
*
Emergency Contact
Name
*
First Name
Last Name
Relation To The Young Person
*
Please Select
Mother
Father
Step Mother
Step Father
Grandfather
Grandmother
Auntie
Uncle
Sibling
Other
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: 00000000000.
Additional Information:
Medical Conditions
Yes
No
Medical Conditions
ADHD - Non Medicated
ADHD - Medicated
ASD
Epilepsy
Diabetes
Other
If any of the above were selected, Please provide additional information below:
Any Allergies/Dietary Requirements
*
Yes
No
If selected Yes, Please provide these below:
Example: Halal, Vegetarian, Vegan, Dairy-Free, Gluten-Free, Or Any Specific Food Allergies.
Does The Young Person Require An Epi-pen
Yes
No
Do You Give Permission For The Young Person To Leave Site During Camp?
*
Yes
No
Tick Yes If You Agree To Photos Being Used On Our Social Media
*
Yes
No
Choose Your Booking Type
Individual - £15 Per Day
Full Week - £60
Which Days Will They Attend?
Monday 27th
Tuesday 28th
Wednesday 29th
Thursday 30th
Friday 31st
Would You Like Updates About Future Camps
*
Yes
No
Day Rate
Week Rate
Days in the week
Days selected
Payment Amount
*
prev
next
( X )
GBP
Description
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
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