Lime Tree Primary Academy Holiday Club Booking Form – October 2017

1st Child’s Name / Date of birth
2nd Child’s Name / Date of birth
3rd Child’s Name / Date of birth

Please complete below to book your child/children into our October 2017 half term holiday club. Please note that bookings must be made and paid for by 3pm on Wednesday 18th October (the week prior to the half term holidays) to secure a place. Bookings will not be accepted without full payment and a completed booking form.

Prices as follows:

Half day session (either 8am to 1pm or 1pm to 6pm) - £10

Full day session (8am-6pm) - £20

Full week session (Monday – Friday 8am-6pm) - £90

Tick in the appropriate boxes:

Half day session am
8am to 1pm / Half day session pm
1pm to 6pm / Full day session
8am to 6pm
Monday 23rd October
Tuesday 24th October
Wednesday 25th October
Thursday 26th October
Friday 27th October

Please indicate below if your child has any allergies, dietary requirements or medical conditions:

I agree to my child’s photograph being used on social media (please tick)

Parent/Carer Name (Please print): ……………………………………………………………

Signature: ………………………………………………………………….

Date: ………………………………

Contact Number: …………………………………………………………

Please state who will be collecting your child/children at the end of the day:

……………………………………………

Emergency contact details: Mobile: ______

Work: ______

Home: ______

Address: ______

Post Code: ______

I have read the terms and conditions below. Please tick here:

·  Payment should be made on ParentPay and must be paid by 3pm on Wednesday 18th October.

·  Refunds cannot be made if a child does not attend a booked holiday club session due to illness or any other reason.

·  Bookings forms must be handed to the school office.

·  The deadline for cancellation or amendment to a session is 3pm on the Wednesday 18th October.

·  Holiday club will open at 8.00am and finish at 6.00pm.

·  Please see holiday club policy for any further information.

THANK YOU FOR BOOKING A PLACE AT LIME TREE PRIMARY ACADEMY HOLIDAY CLUB

______

For Office Use Only:

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