Adventure Pirate Holiday Club Booking Form

Adventure Pirate Holiday Club Booking Form

October Half Term 2024 - Every Mon-Fri For AGES 7+
PLEASE SELECT ALL THE DAYS YOU WISH YOUR CHILD TO ATTEND BELOW:
Date attending.*

DayMonthYear
Date
Date attending.

DayMonthYear
Date
Date attending.

DayMonthYear
Date
Date attending.

DayMonthYear
Date
Child Name*

First NameLast Name
Duration*

Full day £35.00
Birth Date*

DayMonthYear
Parent/Guardian Emergency Contact Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Number*

Area CodePhone Number
Mobile*

Area CodePhone Number
Alt. Phone Number*

Area CodePhone Number
E-mail*
Do the any children have any allergies, chronic illness, or medical conditions? If yes, please describe.
Are any children prescribed an inhaler or any other medication? If yes, please explain any instructions.
Informed Consent and Acknowledgement

My child is aged 7+

I hereby give my approval for my child’s participation in any and all activities prepared by Adventure Pirate LTD.

I am aware that the activities my child will be undertaking are physical and accidental injury/illnesses are possible. These may include, but are not limited to the risk of cuts, bangs, bruises, fractures, paralysis, or death.

If my child is injured, I agree to instructors administering first aid on my child. I am happy to be contacted if this happens.

I agree to any photos/videos of my child participating in activities to be used to promote Adventure Pirate LTD.

I cannot cancel my child's place within 7 days of the session taking place. If I do, I will forfeit my fee and not be offered an alterantive date.
Confirmation

BY BOOKING I AGREE TO ALL OF THE ABOVE STATEMENTS, CONFIRM ALL THE INFORMATION I HAVE PROVIDED IS CORRECT AND ENTER INTO A CONTRACT WITH ADVENTURE PIRATE LTD
Signature

Clear

My Products*

Full day at Adventure Pirate Holiday Club - Ages 7+£35.00

Number of days

Enter coupon

Total £0.00

Payment Methods

Debit or Credit Card

First Name

Last Name

Credit Card Number

Security Code

Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

Should be Empty:

Adventure Pirate Holiday Club Booking Form

PLEASE SELECT ALL THE DAYS YOU WISH YOUR CHILD TO ATTEND BELOW: