SWANSCOMBE HALF TERM HOLIDAY
Monday 13th, Wednesday 15th, Friday 17thFebruary
Please complete a separate form for each child. These forms will be kept on the Bizz Kidz database. Please inform the Bizz Kidz leader if any details change.
All children must have had their 5th Birthday before joining the BIZZ KIDZ Club.
The number of children is limited. Please book in advance. Children are accepted on a first come first served basis.
Bizz Kidz Club is NOT Social Services Registered and therefore will not be operating within their guidelines.
All activities are subject to change.
Although swimming is offered every day, this is not a guaranteed activity.
PLEASE COMPLETE ALL SECTIONS OF THIS APPLICATION FORM
SECTION ONE
Child’s Name (in full): ______Age: ______
Child’s Address: ______
DOB: ______Child’s Religion: ______
E-mail address ______
Child’s First Language Spoken at Home: ______
Responsible Adult’s Name: ______Home Phone No: ______
Emergency Contact Name: ______Emergency No. ______
Doctor’s Name ______Doctor’s Phone No. ______
SECTION TWO
The following activities could be included in Swanscombe Bizz Kidz Club programme. Please specify if you would like your child to participate in any of the activities listed.
Bouncy CastleYes/No
Trampolines (only with qualified coach)Yes/No
Ball Sports/GamesYes/No
Promotional PhotosYes/No
Outside Areas(access through car park)Yes/No
Face PaintingYes/No
SECTION THREE
Please indicate if your child has any allergies or special needs:
Allergies (please state):Yes/No______
FoodYes/No ______
Drink Yes/No______
Other Yes/No______
Special needs (e.g. Autism, ADHD, etc.) Yes/No______
Medication: Yes/No______
Ailments: Yes/No______
SECTION FOUR
Terms and Conditions
Bizz Kidz isNOT SocialServices Registered and therefore does not operate under their guidelines.
Gravesham Community Leisure Limited reserves the right to withdraw or change any programmed Bizz Kidz activity.
A suitable adult will register the child each morning, completing details of persons authorized for collecting the child at the end of the session.
A signed letter of consent is required for children walking home alone.
Application forms must be completed fully for each child when they join Bizz Kidz Club, including details of special needs, allergies and ailments. Bizz Kidz Staff must be informed in any information changes.
A child should have had their fifth birthday but not their fourteenth birthday on attending Bizz Kidz Club session.
I agree to abide by the terms and conditions;
Signed ______Date ______
Name of Parent/Guardian ______(Print)
Please indicate which days you wish to book. Payment is required at time of booking.
Date / Monday15th / Wednesday
17th / Friday
19th
Please tick required dates
Reception – please complete the following in full:
Child Inclusion form. (Special needs/ illness/ disability)
Please help us by providing as much information about your child’s special needs/ illness/ disability as you can. This will allow us to work with your family to create an inclusion plan tailored to your child’s needs. This may mean that in certain circumstances support from a family member or personal assistant may be required. Each child’s needs will be assessed on an individual basis. Further information can be added at the bottom of this form.
Can My Child……. / YES / NO / CommentsDress/ undress his or her self before and after swimming?
Cope with loud noises and changes with light and audio differences throughout the centre?
Safely walk as part of a group through the centre and through outside areas.
Take part in group/ team activities?
Understand and follow simple instructions?
Feed his or her self?
Use verbal communication?
Use the toilet independently?
Take any prescribed medication independently?
Swim competently?
Is my Child likely to……..
YES / NO / CommentsRun off?
Display forms of challenging/ aggressive behaviour?
Need a quiet calm area?
Need additional support at times?
Need at least one on one support?
Communicate in alternative languages/ formats?
Further information…….