Holiday Club

Please note that if you book a place for your child/children but do not pay at the time of booking and then your child does not attend, you will still be billed for that place, unless we are given 24 hours notice to cancel, if you cancel your place we will issue you with a credit.

1. Parent / Carer Name

1. Address

1. Telephone
2. Mobile
3. Email
4. Which School does your child attend?
5. Name of persons with permission to collect your children
6. Emergency Contact Name
7. Emergency Phone Number
8. Who has parental responsibility for the child?
9. Who has legal contact with the child/children?
10. What is your ethnic origin?
11. Doctor Name
12. Doctor Number

Select Club

1. Farnham St Polycarp's School
2. Is this the first time you have used Casa Holiday Clubs

Child 1

1. Child Name
2. Child DOB
3. Child Medical, Dietary Requirments or Additional Info

Child 2

1. Child Name
2. Child DOB
3. Child Medical, Dietary Requirments or Additional Info

Child 3

1. Child Name
2. Child DOB
3. Child Medical, Dietary Requirments or Additional Info

February 2012	Mon 13	Tue 14	Wed 15	Thu 16	Fri 17

Full Day

Half Day

I have confirmed I have read and unstood The Casa Club Terms & Conditions and agree to abide by them
I agree to my child's photo being taken and used for Casa Club
marketing purposes including being used on the website
For special offers/promotions I confirm that I can be contacted by email
I agree to Casa Team members applying sun cream/insect bit cream on my child