Registration Form
Section 1 - Child's Information
Child's Full Name
*
First Name
Last Name
Known as
Date of Birth
-
Day
-
Month
Year
Date
Gender
Child's Home Addresss
Street Address
Street Address Line 2
Town/City
County
Post Code
Section 2 - Emergency Contact Details
Name
First Name
Last Name
Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Relationship to Child
Can Collect Child?
Yes
No
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Relationship to Child
Can Collect Child?
Yes
No
Section 3 - Booking
We have 16 spaces available each day, at a cost of £65.00 per day.
Which days would you like your child to attend holiday club?
Rows
Monday
Tuesday
Wednesday
Thursday
Friday
Week 1 - (6th - 10th July)
Week 2 - (13th - 17th July)
Week 3 - (20th - 24th July)
Week 4 - (27th - 31st July)
Sessions run from 8am - 4pm each day
Our admin team will be in touch to confirm availability
Section 4 - Medical/Health Information
Please provide details of any medical conditions of which the holiday club team should be aware. (e.g. asthma, allergies, eyesight/hearing difficulties, epilepsy etc.)
Does your child have any medical conditions, disabilities, allergies, additional support needs or receive regular medication?
Yes
No
If yes, please provide details (if no, please write 'not applicable')
*
Do you give permission for staff to apply sunblock/midge repellent to your child if deemed necessary?
Yes
No
Do you need to provide information relating to religion e.g. observance of religious festivals or prohibited foods?
Yes
No
Does your child have any non medical dietary requirements e.g. vegan, vegetarian?
Yes
No
If yes, please provide further details:
Section 5 - Any Other Relevant Information
Please provide details here:
Section 6 - Permissions
I declare my child medically fit to participate in holiday club outdoor activities both on and off site. I undertake to notify holiday club in the event of any change to my child's health. I understand that there is an element of risk involved in taking part in outdoor activities and I accept the risk. I give holiday club personnel the authority to administer any first aid treatment necessary to preserve my child's life. I agree to emergency surgical and dental treatment being administered to my child, as considered necessary by professional medical authorities.
I consent
I do not consent
I accept that personal belongings are not covered by holiday club insurance and that holiday club will not be held liable for damage or loss of these items.
I consent
I do not consent
At times photographs and videos may be used in holiday club publicity, publications on our website, including social media.
I consent
I do not consent
I consent to my personal email being added to the Little Bugs/Wild Bugs mailing list. This list will be used to provide information/updates regarding our settings. At no time will your email be given, sold or passed on to a third party without your consent.
I consent
I do not consent
Section 7 - Terms & Conditions
I understand that in order to allow for adventuring off site, children should be dropped of at Little Bugs Abercorn between 8am - 9am and picked up between 3pm - 4pm.
Yes
I understand that requested holiday club sessions must be paid for in full before they are secured. Our admin team will send out an invoice payable one week from date of issue upon processing your form.
Yes
I understand that forms will be processed on a first come first serve basis.
Yes
I understand that any regular medications my child may require must be handed in to a member of holiday club personnel each morning and taken away each afternoon. Medication forms will be filled out upon arrival each day.
Yes
I understand that if my child becomes unwell or if staff feel that your child isn't well enough to engage in holiday club activities on arrival, we will require you to take them home.
Yes
I understand that my child must have completed Primary 1 before attending holiday club.
Yes
Signature of Parent/Guardian
Name
First Name
Last Name
Date
-
Day
-
Month
Year
Date
Register
Register
Should be Empty: