Holiday booking form

1
What is your name?* This field is required.Parent/Carer Full Name
First Name
Last Name
2
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
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Algeria
American Samoa
Andorra
Angola
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The Bahamas
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Western Sahara
Yemen
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Zimbabwe
Other
Country
3
Phone Number* This field is required.Contact Number
Please enter a valid phone number.
4
Please provide your Email address* This field is required.
example@example.com
5
Child's full name?* This field is required.
First Name
Last Name
6
What is your child's date of birth?* This field is required.Child’s Date of Birth
Date
Day
Month
Year
7

Povider Name: Our Special Angels - Wilson Stuart

Provider Number: 2863422

Provider Awarding Body: OFSTED

Provider address: Wilson Stuart School, Perry Common Road, Erdington, B23 7AT

Bank details: Our Special Angels Limited

Sort Code: 23-05-80

Account Number: 50675181
8

Povider Name: Our Special Angels - Calthorpe

Provider Number: 2863425

Provider Awarding Body: OFSTED

Provider address: Calthorpe Academy, Darwin Street, Birmingham, B12 0TP

Bank details: Our Special Angels Limited

Sort Code: 23-05-80

Account Number: 50675181
9

Povider Name: Our Special Angels - Brays

Provider Number: 2863423

Provider Awarding Body: OFSTED

Provider address: Brays Special School, Brays Road, Birmingham, B26 1NS

Bank details: Our Special Angels Limited

Sort Code: 23-05-80

Account Number: 50675173
10

Povider Name: Our Special Angels - Walsall Centre

Provider Number: 2863424

Provider Awarding Body: OFSTED

Provider address: 18 Lichfield Street, Walsall, WS1 1TJ

Bank details: Our Special Angels Limited

Sort Code: 23-05-80

Account Number: 56272402
11
Which site would you like your child to attend?
Calthorpe Academy (B12 0TP) Only select if your child attends this school term time.
OSA Walsall Centre 17 Lichfield St (WS1 1TJ) Suitable for children who enjoy a more active, energetic environment, that require space to move freely.
OSA Walsall Centre 18 Lichfield St (WS1 1TJ) Suitable for wheelchair users and children who benefit from a calmer, more structured environment with lower noise levels.
New Horizons (B23 6UB) Not Running This Holiday
Brays School (B26 1NS) Not Running This Holiday
Queensbury School (B24 8BL) Not Running This Holiday
Wilson Stuart School (B23 7AT) Only select if your child attends this school term time.
The Bridge School (B73 6UE) Not Running This Holiday
OSA Birmingham Centre (B15 1AU) Suitable for both Wheelchair users and non wheelchair users
Dame Ellen School (B13 0RW) Not Running this Holiday
12
Brays School – Please select the sessions you would like to book:* This field is required.
NOT RUNNING THIS HOLIDAY
13
OSA Birmingham Centre (11-4pm)– Please select the sessions you would like to book:* This field is required.
Monday 26th October 2026
Tuesday 27th October 2026
Wednesday 28th October 2026
Thursday 29th October 2026
14
Calthorpe Academy – (10am to 3pm) Please select the sessions you would like to book:* This field is required.Which days would you like to book? Please select all that apply.
Monday 26th October 2026
Tuesday 27th October 2026
Wednesday 28th October 2026
Thursday 29th October 2026
15
The Bridge – Please select the sessions you would like to book:* This field is required.Which days would you like to book? Please select all that apply.
NOT RUNNING THIS HOLIDAY
16
Wilson Stuart School (10am to 3pm)– Please select the sessions you would like to book:* This field is required.Which days would you like to book? Please select all that apply.
Monday 26th October 2026
Tuesday 27th October 2026
Wednesday 28th October 2026
Thursday 29th October 2026
Other
17
Queensbury School – Please select the sessions you would like to book:* This field is required.Which days would you like to book? Please select all that apply.
NOT RUNNING THIS HOLIDAY
18
New Horizons – Please select the sessions you would like to book:* This field is required.Which days would you like to book? Please select all that apply.
NOT RUNNING THIS HOLIDAY
19
OSA Walsall Centre 18 Lichfield St (11-4pm)– Please select the sessions you would like to book* This field is required.
Monday 26th October 2026
Tuesday 27th October 2026
Wednesday 28th October 2026
Thursday 29th October 2026
20
OSA Walsall Centre 17 Lichfield St (11-4pm)– Please select the sessions you would like to book* This field is required.
Monday 26th October 2026
Tuesday 27th October 2026
Wednesday 28th October 2026
Thursday 29th October 2026
21
Dame Ellen – Please select the sessions you would like to book* This field is required.
NOT RUNNING THIS HOLIDAY
22
What school does your child attend?What school does your child attend term time?
23
I agree to obtain from my child's school his/her All About me/school passport document and share it with Our Special AngelsThis is a document that school hold about your child's specific needs. It will help OSA to meet your child's needs. Please email this to info@ourspecialangels.co.uk
YESNO
24
Does your child have any additional needs we should be aware of?
Huge
Large
Normal
Small
Ok
Ok
25
Does your child have any allergies?* This field is required.please give details of allergy or type No if they do not have any allergies
Huge
Large
Normal
Small
Ok
Ok
26
Is your child new to Our Special Angels?* This field is required.If your child is new to Our Special Angels, you will receive an email containing a link to complete our online All About Me Form. This must be completed before your child's first session. We also ask that you provide a copy of your child's most recent School Passport, My Support Passport, or All About Me document from their school. This can be emailed to us before your child's first session or brought along on the day. If you do not already have a copy, please contact your child's school, who will be able to provide this for you. These documents help us understand your child's needs and ensure we can provide the best possible support during their time with us.
YESNO
27
Does your child require medication to be administered while they are with us?If yes you will receive an email containing a medication consent form
YESNO
28
Does your child suffer from Epilepsy?If yes please email us a copy of your child's Epilepsy care paln which can be obtained from your child's School. We must have this before your childs first session with us.
YESNO
29
Do you give consent for pictures to be taken and shared on the parents’ WhatsApp group?* This field is required.
YESNO
30
Can we use your child’s photo on our social media platforms?* This field is required.
YESNO
31
What are your child's personal care needs?* This field is required.
Independent
Independent but needs help washing
In nappies – changed by 1 person
In nappies – changed by 2 people
Hoisted – by 1 person
Hoisted – by 2 people
32
Is your child PEG fed.* This field is required.PEG fed" refers to feeding a person through a Percutaneous Endoscopic Gastrostomy (PEG) tube, which is inserted into the stomach. If yes you will receive an email containing more details.
YESNO
33
How will you be paying for your child’s place?* This field is required.Payment type
I will be paying privately (£100/day)
I pay monthly and do not require an invoice
I will be using Direct Payments (£100/day)
An agency will be paying on my behalf (£100/day – invoice will be sent to agency)
I will be using Student Finance
I will be using Tax-Free Childcare
I will be using Childcare Vouchers
I will be using my childcare element from universal credit
I have been offered Free Short breaks Sessions (only select this if you have confirmation from Management)
34
Please provide the email address of the agency who will be covering the cost.* This field is required.
35
Total to payPlease use your child's first and second name as payment reference
36
Please confirm.* This field is required.
I understand that payment for my child's booked sessions must be made by Monday 12th October 2026.I understand that if payment is not received by this date, my child's place is not guaranteed.
37
Agreement to Booking Terms* This field is required.I understand that bookings are for full-day sessions only, and no refunds will be given if my child leaves early or requires reduced hours for any reason.I also understand that if my child is self-harming, harming others, or becomes extremely distressed, I will be asked to come and pick them up. The team will then work with me to create a plan, which may include reduced hours to help my child settle safely.
I have read and agree to the booking terms and conditions
38
Please provide an emergency contact (1) We’ll only get in touch with the emergency contact when we are not able to get through to you
First Name
Last Name
39
Relationship to child
40
Emergency contacts telephone number (1)
Please enter a valid phone number.
41
Please provide an emergency contact (2) We’ll only get in touch with the emergency contact when we are not able to get through to you
First Name
Last Name
42
Relationship to child
43
Emergency contacts telephone number (2)
Please enter a valid phone number.
44
Todays Date
Date
Day
Month
Year
Should be Empty: