Parents Name

Email Address

Home Address

Contact Number

Emergency contact number

Name, Age and DOB of Child Attending

Name, Age and DOB of Child Attending

Name, Age and DOB of Child Attending

Name, Age and DOB of Child Attending

Who will be collecting your child?

Has your child attended a holiday club before? Has your child attended a holiday club before? Yes No

If you answered yes to the above please let us know which one.

Doctors Name and Address

Please advise if your child has any allergies. Please advise if your child has any allergies. No Yes

If you answered Yes to the above please provide details.

Do you know if your child has had a reaction to 'arts and craft' materials ie paints, glue, glitter etc.* Do you know if your child has had a reaction to 'arts and craft' materials ie paints, glue, glitter etc.* No Yes

If you answered Yes to the above please provide further details.

A Pack Lunch is provided. Please confirm you would like one. A Pack Lunch is provided. Please confirm you would like one. Yes No

Is your child allowed a snack and drink whilst at poponin? Is your child allowed a snack and drink whilst at poponin? Yes No

My Club Time is My Club Time is 9.00am - 1.00pm

Day(s) you are visiting?

If you would have booked multiple dates please list these in the space below.

HAF ID

poponin take photos/video for promotional purposes. Are you OK with your child being in photos/video?* poponin take photos/video for promotional purposes. Are you OK with your child being in photos/video?* Yes No

Would you like to receive the poponin newsletter? Would you like to receive the poponin newsletter? Yes No

Please use this space for any other information you think useful or helpful to the poponin team. Thank You.

Please Confirm Please Confirm I confirm I have read the Terms and Conditions*

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