Holiday Club Booking

Fill in form below

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

Child 1

1. Child Name
2. Child DOB
3. Can your child swim No Yes
4. Child Medical or Dietary Requirments

Child 2

1. Child Name
2. Child DOB
3. Can your child swim No Yes
4. Child Medical or Dietary Requirments

Child 3

1. Child Name
2. Child DOB
3. Can your child swim No Yes
4. Child Medical or Dietary Requirments

February 10	Mon 15	Tue 16	Wed 17	Thu 18	Fri 19

Full Day

Half Day

April 10	Tue 06	Wed 07	Thu 08	Fri 09

Full Day

Half Day

April 10	Mon 12	Tue 13	Wed 14	Thu 15	Fri 16

Full Day

Half Day

June 10	Tue 01	Wed 02	Thu 03	Fri 04

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 my child swimming
I agree to Casa Team members applying sun cream/insect bit cream on my child