KIDS DOMAIN - Change of Booking & Written Notice Form

Change of Bookings, Updates and Written Notice Form
Please Choose The Programme Your Booking is Through*

Four DiamondsKids Domain
Centre Location*

Stokes ValleyLower HuttWilfordEpuni
Child(ren) Name(s)*
Type of Care this relates to:*

School Term Care (before and after school care)School Holiday Programme/Workshops
School Holidays - Please select as many as you like*

I want to give permission for my child to sign themselves in or leave the programme unattendedI need to update my child's booking details (eg new authorised pickup person, address changes etc)I need my half day holiday care increased to a full days careI need my full days holiday care decreased to a half days careI need to book additional daysI want to give Written Notice to cancel care
School Term - Please select as many as you like*

I want to book in additional days to my current booking (eg 3 days to 4 days)I want to permanently cancel a booked day(s) - 2 weeks notice requiredMy child will be away for 6 or more consecutive days (AND WANT MY PLACEMENT HELD - 2 weeks notice required)I want to give permission for my child to sign themselves in or leave the programme unattendedI need to update my child's booking details (eg new authorised pickup person, address changes etc)
Please Choose Additional Days to Be Booked in Permanently*

Monday Before SchoolMonday After SchoolTuesday Before SchoolTuesday After SchoolWednesday Before SchoolWednesday After SchoolThursday Before SchoolThursday After SchoolFriday Before SchoolFriday After School
When are the additional days to start?*

DayMonthYear
Date
Please select which days you would like to cancel*

Monday Before SchoolMonday After SchoolTuesday Before SchoolTuesday After SchoolWednesday Before SchoolWednesday After SchoolThursday Before SchoolThursday After SchoolFriday Before SchoolFriday After School
Please advise date of last date of care*

DayMonthYear
Date
Please note any other information we need to know e.g dates of care to be cancelled or dates you would like to add etc*
PARENT/CAREGIVER FULL NAME*

First NameLast Name
Email Address for a copy of this form to be sent to*

Confirmation Emailexample@example.com
How would you like to receive confirmation?*

by emailby phone callAny
Please verify that you are human*
DATE SIGNED

DayMonthYear
Date
Should be Empty:

Change of Bookings, Updates and Written Notice Form