Holiday Club - Payment Form 2

Monday 12th February 2024 to Friday 16th February 2024

Contact details for your child

Family Name (Surname) :* First Name :* Date of Birth :* Parent / Carer Name :* Contact Details (telephone) : Emergency Contact :* Parent / Carer email address :* My child will be collected by:*

My child can walk home alone :*YesNo

Your Child

Child's Full Name* School & Class*

Does your child have any medical needs?*YesNo

If yes, please provide details. Please note should your child require medication to be administered during their time at the Holiday Club a consent form will need to be completed.

Does your child have any additional needs?*YesNo

If yes, please give details:

Sessions

We provide the following sessions from Monday 12th to Friday 16th February

DAILY SESSION 08:45 - 16:45 (£20)
ADDITIONAL HOUR (MORNING) 07:45 - 08:45 (£5)
ADDITIONAL HOUR (EVENING) 16:45 - 17:45 (£5)

TRIPS (£15) Please note we have a limited amount of spaces per trip, therefore early booking is advised to avoid any disappointment.

ADVENTURE PLAY (TUES)

BOWLING (THUR)

Please note that children have to be 5 years old and over to attend any trip.

Monday 12th February 2024DAILY SESSION - £20EXTRA HOUR (AM) - £5EXTRA HOUR (PM) - £5Lunch required - £2.50I will provide a packed lunch

Tuesday 13th February 2024DAILY SESSION - £20EXTRA HOUR (AM) - £5EXTRA HOUR (PM) - £5Lunch required - £2.50I will provide a packed lunchAdventure Play Trip - £15.00

Wednesday 14th February 2024DAILY SESSION - £20EXTRA HOUR (AM) - £5EXTRA HOUR (PM) - £5Lunch required - £2.50I will provide a packed lunch

Thursday 15th February 2024DAILY SESSION - £20EXTRA HOUR (AM) - £5EXTRA HOUR (PM) - £5Lunch required - £2.50I will provide a packed lunchBowling Trip - £15.00

Friday 16th February 2024DAILY SESSION - £20EXTRA HOUR (AM) - £5EXTRA HOUR (PM) - £5Lunch required - £2.50I will provide a packed lunch

I have read and accept the Terms & Conditions for Mission Grove Primary School Holiday Club*YesNo

Our school dinners cost £2.50 per day. If your child brings a packed lunch no items can contain NUTS or GELATINE. Please state if your child has any special dietary requirements due to allergic reactions, cultural or religious beliefs. Print Full Name & Date*

I give consent for my child to be photographed or filmed and these images may be used on the school website and / or twitter account or Local Authority promotions.*YesNo

Print Full Name & Date*

Payment

I would like to payONLINECHILDCARE VOUCHERS

Childcare Reference Number*

If you selected ONLINE payment, you should use the button on the next page to pay immediately.

If you have chosen Childcare vouchers, the school office will be in touch.

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Holiday Club - Payment Form 2

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