Multi-Sports and Activity Club Bookings

Childs Full Name*

First Last

Child's Preferred Name

Please let us know if they wish to be addressed by a preferred name.

Date of Birth- Child cannot attend under the age of 5*

Which Key Stage

Key Stage One - Reception to Year 2 Key Stage Two - Year 3 to Year 6

Child's School*

If the child's school is not listed please select other.

If School is Other then please state.

Parent/Carers Full Name*

First Last

Email Address*

Contact Number*

Address*

Street Address Address Line 2 Town County Post Code

Second Emergency Contact Name (must be different to above)*

First Last

Second Emergency Contact Number*

Please provide the telephone number of the person you have named as your emergency contact.

Does your child have any medical needs or disabilities we should be aware of?*

Please give further details of medical needs or disabilities:

Does your child have any special educational needs we should be aware of? (Please be aware that due to staffing ratios we are unable to provide one to one care)*

Please give details of SEN needs:

Does your child have any dietary requirements/ food allergies we should be aware of? If yes, please state:*

Seeking Medical Help Permission*

In the event of an emergency, I give permission for the Activity Club staff to seek necessary emergency medical advice or treatment. (Please note we will always contact you immediately)

Photo Permission*

Whilst at the Activity Club there are a number of occasions when your child's photo might be taken, for example for use to our website & social media. Are you happy for us to take photos of your child and for them to be displayed?

SHARES Lancashire Multi-Sport Activity Club Terms and Conditions*

SHARES Clubs are for 5 to 11 years only. We do not accept children who are below or above this age range. All children who attend a multi-sport club must be prepared and willing to join in to our range of sports delivered. Any children attending SHARES clubs who require personal care in addition to the delivery of our activities, will require their parents to come and provide that care or when necessary take the the child home. We will NOT tolerate any bullying, foul language or unreasonable behaviour at SHARES Multi-Sport Activity Clubs. We endeavour to create a warm and welcoming environment for all children. However if behaviour deemed unacceptable occurs the SHARES manager will inform you verbally and if necessary due to the level of the incident send the child home. If the behaviour continues your child would be asked to leave the club for that day and the following day. If your child is asked to leave, these days will be non-refundable. After this if the unacceptable behaviour continues, they will be asked to not return for the rest of the week. On the third occasion, the child will not be able to attend for the rest of the club. Personal possessions such as mobile phones, toys, money, fidget toys are NOT to be brought to Activity Club. We do accept any responsibility for lost or damaged personal items. All payments need to be made in full to secure the booking. Bookings made without payment will not be accepted and the booking form will have to be started again in order to make payment. Once dates are booked we will be only be able to refund your booking 3 working days prior to the holiday club starting. If you or your child is unhappy with the SHARES Activity Club or staff, please discuss your concerns with the SHARES Activity Club Manager. Your concerns will be treated with respect and confidentiality.

Please tick to state you have read and agree to the above terms and conditions

SHARES Activity Clubs are a NUT FREE environment. Please tick to say you have understood*

Yes

Please check ingredients on anything being sent into the holiday club. For example snickers, Peanut butter, any type of nuts, Nutella or other hazelnut spreads, reeses, and any Kinder products Items containing nuts will be removed.

We would like to send you information in regard to our Activity club by telephone, SMS and email. Please tick the relevant boxes of how you would like to be contacted:*

SMS

Telephone

October Half Term

Monday 26th October

Tuesday 27th October

Wednesday 28th October

Thursday 29th October

Friday 30th October

Daily Cost - SHARES School

Price: £ 17.00

Daily Cost- Non SHARES School

Price: £ 22.00

Weekly Cost (5 days) SHARES School

Price: £ 75.00

Weekly Cost (5 days) Non- SHARES School

Price: £ 100.00

Total

Payment Method

Multi-Sports and Activity Club Bookings

SHARES Multi-Sport Activities Club - October Half Term

Contact Details

Contact Details

“Raising Education Standards”