Christmas Camp Booking Form

Participants Name *

First

Last

Gender

Date of Birth

Primary School

Are siblings of the participant also attending the camp? *

Yes
No

Please tick days participant will be attending

Monday 19th December 9 - 1pm
Tuesday 20th December 9 - 1pm
Wednesday 21st December 9 - 1pm
Thursday 22nd December 9 - 1pm

Parent/Guardian Name

Parent/Guardian Email

Parent/Guardian Telephone number

Parent/Guardian Address - First Line

Parent/Guardian Address Second Line

Parent/Guardian Address Postcode

Name of Second Parent/Guardian

Contact number of second Parent/Guardian

Does the participant have any dietary requirements *

Yes
No

If yes, please give details.

Does your child have special education needs or disability? *

Yes
No

If yes, please give details.

Is the participant in receipt of benefit-related Free School Meals (FSM)? *

Yes
No

If yes, please give your child's unique allocations code

We may take photographs and videos of the activity session, please specify if you are happy for your child/children to be featured in these images which maybe used on our website and social media pages. *

Yes
No

For child safety we ask you give a password below which the guardian/parent will need to give when collecting child/children from the session.

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