October Half Term
Holiday Club
Child's Name
*
First Name
Last Name
Preferred name
Parent Name
*
Mrs
Mr
Miss
Ms
Dr
Prof
Revd.
Prefix
First Name
Last Name
Parent Email address
*
example@example.com
Contact phone number
*
Is your child enrolled at Rossall School?
*
Yes
No
Back
Next
Child's sex
*
Male
Female
Date of Birth
*
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Name of current school
*
Current school year
*
Year 4
Year 5
Year 6
Year 7
Does your child have any special needs or disabilities
*
Yes
No
Please provide details
Does your child have any special educational needs
*
Yes
No
Please provide details
Does your child suffer from a medical condition or take any regular medication
*
Yes
No
Please provide details
Does your child have any dietary requirements
*
Yes
No
Please provide details
Back
Next
Parent / Guardian signature
*
By signing this box you confirm all the information given is correct
Date
*
My Products
prev
next
( X )
Half Term Computer Club
£80.00
£80.00
£
80.00
Quantity
1
2
3
4
5
6
7
8
9
10
Submit
Should be Empty: