Holiday Club Contact Form Holiday Club Contact Form 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 School your child attends If you answered yes to the above please let us know which one. School Year (s) of child(ren) Who will be collecting your child? Has your child attended a holiday club before? Has your child attended a holiday club before? Yes No 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. Does your child have any learning difficulities or learning assistance at school. Does your child have any learning difficulities or learning assistance at school. No Yes If you answered Yes to the above please provide more information. Thank You. Does your child have any disabilities. Does your child have any disabilities. No Yes If you answered Yes to the above please provide more information. Thank You. Is your child allowed a snack and drink whilst at poponin? Is your child allowed a snack and drink whilst at poponin? Yes No Which Club would you like to attend? Which Club would you like to attend? Full Day 9.00 - 5.00pm £44.00 (6 yrs +) Short Day 9.00 - 3.00pm £30.00 (5 yrs, Year 1+) 4 Hour Flexible £24.00 (5 yrs +, 4 yrs welcome if attending with older sibling) 3 Hour Flexible £18.00 (5 yrs +, 4 yrs welcome if attending with older sibling) 1 Hour Flexible (start time to suit you) £9.00 (5 yrs +) Day(s) you are visiting? If you would like to book multiple dates please use the space below. Payment Method - payment is required in advance of club date. Payment Method - payment is required in advance of club date. Payment Method - credit card 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 Already Receiving 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* When submitting this form, it will fade in colour and a message will appear at the top of the page saying 'Thank you for your submission we look forward to seeing you'. If the page doesn't change it indicates a field in the form has not been filled and will have a red box around it. Please take a moment to check your form as the form will not be received.Thank You! 14 + 8 = Submit Thank You.
