PersonalDetails

SNAAPBOOKINGFORM–February halfterm2018

Parent /CarerName / Email
HomeContact No. / Address
MobileContact No.
Childs Name / Childs
Age / Detailsof Disability / Wheelchair
User(Y/N)

Booking Details

Trip/ Event / Date / Ages / No. of
Carers / No. of
disabled
children / No. of
add.
children / No. of
add.
adults / Cost / Total
Cost
Filmclub– Emoji / Tues 13th Feb / All / Free
*Lunch box / All / £1perchild
*Dietary needs
Play Zone / Sun 11th Feb / All / £8.50perchild
*Dietary needs
BuzzClub 8-15yrs
*MUSTcomplete / Wed14th Feb / 8-15 years / £10.00each
Fri 16th Feb / 8-15 years / £10.00each
ChillZone16-25yrs
*MUST complete / Tues13th Feb / 16- 25
years / £10.00 each
Thurs 15thFeb / 16- 25
years / £10.00 each
Totalcost
*FORBUZZCLUBandCHILLZONEONLY –mustbecompleted tobe offereda place*
School/college
attended / Doesyourchildhavean EHCPor Statementof
SEN? / Yes / No
AllocatedSocial
Worker’s name / Doesyourchildattendaspecialschoolorin
a unitattached toamainstreamschool? / Yes / No

Payment

I havepaidin full
I havepaidbyBACSpayment(pleasepayintoourbankusingthefollowingdetails) SortCode–309961
Account–15794968
Referencetobe– your name
BuzzClub –I haveenclosedaCarePlan (onlyrequiredif notsentpreviously)Pleasenote: Your childwillnot be offered aplacewithoutthis.
OFFICEUSE ONLY / Amount Paid £ / Cash/Cheque / Signed / Date / /

Thank youforbooking onan event. If youhaveanideaforatrip /eventplease email