*

First Name

Last Name

Date of birth *

MM

DD

YYYY

*

First Name

Last Name

Contact number *

(###)

###

####

Alternative contact number

(###)

###

####

Does this person have parental responsibility? *

Yes

No

Primary address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Does the child normally live at this address? *

Yes

No

*

First Name

Last Name

Contact number *

(###)

###

####

Alternative contact number

(###)

###

####

Does this person have parental responsibility? *

Yes

No

Secondary contact address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Does the child normally live at this address? *

Yes

No

Does your child have any medical issues/special needs we need to be aware of? *

E.g. Allergies, intolerances, asthma, diabetes, autism, ADHD, restlessness, trouble with anger, etc. If so, we will send you a medical form to complete.

Yes

No

Are you eligible for any of the following discounts?

We will ask to see proof of eligibility so we can approve your discount.

Blue Light Card

Armed Forces Discount

Student Discount

Which days you would like to book for? (9am - 4pm) *

£30 per day or £125 for the week (5 days)

Monday 28th October

Tuesday 29th October

Wednesday 30th October

Thursday 31st October

Friday 1st November

Which days you would like to book the Breakfast Club for? (8am - 9pm) *

£10 per day or £37 for the week (5 days)

Monday 28th October

Tuesday 29th October

Wednesday 30th October

Thursday 31st October

Friday 1st November

Print name *

First Name

Last Name

By ticking this box, you confirm that all of the information you have provided is current and accurate. *

Any incorrect information may result in a non-refundable termination of your booking.

I confirm