Leir Language Academy - Easter Camp Registration

Child's Information
Childs Name*

First NameLast Name
Age*
Gender*
Are you registering more than one child?*

YesNo
Does the child have any allergies, or medical conditions? If yes, please describe.*
If None plesae put None
Additional Children
Do any of the above childern have any allergies, or medical conditions? If yes, please describe.*
If None plesae put None

Other required information
Will your child be dropped off and or collected by anyone other than a parent or guadian?*

YesNo
Person collecting child*

First NameLast Name
Contact number*

Area CodePhone Number
Relationship to Child?*
Person dropping child (if different from above)

First NameLast Name
Contact number (if different from above)

Area CodePhone Number
Doctors Name*

First NameLast Name
Contact Number*

Area CodePhone Number
Please put any other information or details you feel we should be aware of which may affect the child, other childeren or staff during the camp. If none, put None*

Other way to pay balance (Reservation fee is required with this registration)*

Banking OnlineCash in person
Details to pay your balance by banking online are:
- ACCOUNT NAME: Leir Education Limited
- BANK ADDRESS: Kildare Town, Co. Kildare, Rep. Ireland
- SORT CODE: 901167
- ACCOUNT NO: 60750663
- IBAN: IE82BOFI90116760750663
- BIC: BOFIIE2DXXX
- IMPORTANT: Please put CHILD'S NAME as the payment reference.
To pay any outstanding balance in cash, please contact Peter Donnelly by any of the following methods:
- Email peter@leir.ie or phone 045 432 658 / 086 265 3548 to arrange a suitable time to meet in the office.

Fun with Spanish Easter Camp*

Reservation FeeThis reservation fee is non-refundable unless we cancel the camp

€25.00 Quantity
Item subtotal:€0.00

Fun with Spanish Easter CampPayment balance

€45.00 Quantity
Item subtotal:€0.00

Subtotal

€0.00

Tax

€0.00

Total

€0.00

Brief terms and conditions

Please note that should the person enrolled not attend the course for any reason or any duration of the course, camp or program, fees and payments are non-refundable unless a minimum of 24 hours notice has been sent to peter@leir.ie

Leir Language Academy and or Leir Education reserves the right to cancel a course due to insufficient enrollment. In any such event, all fees will be refunded in full.

Important: All participants must be collected no later than 10 minutes after the camp finishes, in the event of a delay please contact Peter at 086 2653548 or Maria at 083 420 3080 and notify them of the delay.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Enter the message as it's shown*
Should be Empty:

Fun with Spanish Easter Camp