School / College Attended (If Appropriate)

Easter Holiday Project

9thApril – 13thApril

Registration Form

Please note if the young person being registered has attended recently and there are no changes to inform us of, we are happy to use registration forms already held by Lifeworks – please always let us know of any updates in the context of care and emergency contacts and complete and return the finance remittance form (page 4).

Name of young person……………………………………………………………………………………………………

School / College attended (if appropriate)………………………………………………………………………………….

Holiday clubs / social groups attended ………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………….

Support Needs

1. Sight difficulties Yes / No

1. Hearing difficulties Yes / No

1. Dietary Needs Yes / No

1. Mobility Yes / No

1. Special Communication Needs Yes / No

1. Favourite things to do/play/participate in

1. Least favourite things to do/play/participate in

1. Behavioural Issues Yes / No

1. Fears Yes / No

1. Any issues around any of the activities on the programmeYes / No

1. Other significant information

Parent Guardian Name (in block capitals)

………………………………………………………………………………………

Contact information (mobile and e-mail)

……………………………………………………………………………………….

………………………………………………………………………………………

Signed ………………………………………………………………… Date ……………………………………..

Please return by 23March 2018along with

• Medical form & emergency protocols
• Media release form
• Payment remittance advice (page 4)

Via e-mail to Tanya Bedford e-mail: f you have any questions or would like support to complete this form you can contact Tanya Mondays and Thursdays T: 01803 861069. (Please see our cancellation policy on Page 5)

Name of Participant ______

□Tick box - I have paid £250.00 by BACS.Datetransferred: ______

To pay by BACS, please use the following information:

Bank: Lloyds Bank (Totnes Branch)

Account: Lifeworks Charity Limited - Operations

Sort Code 30-98-69 Account 02293621

Please enter the following reference so that we can ensure it stands out and is easily identifiable.

Easter18 – followed by the young person’s surname

□Tick box - I enclose a cheque for £250.00 made payable to: Lifeworks Charity Ltd.

Deliver to: Lifeworks Holiday Project, Blacklers, Park Road, Dartington Hall Estate, Totnes TQ9 6EQ

Please return payment by Friday23 March 2018

Payee details

Signature:______

Name: (print)______

Date:______

For Finance Use ONLY

Cheque paying in reference ______Date __ __ / __ __ / __ __

BACS received as per Bank StatementDate __ __ / __ __ / __ __

Cancellation Policy:

If for any reason you/the young person in your care cannot attend please give as much notice as possible – see charges below. We will of course make allowances in exceptional circumstances e.g. seizure - please contact team leader directly in this instance but otherwise we will have to charge as the staff will be in place to provide ratio support:

100% refund 60 days notice

50% refund 30 days notice

25% refund 7 days notice

0% refund less than 7 days notice.

100% refund if for any reason Lifeworks has to cancel the project or change the dates.

For further information about the Holiday Project please contact Tanya Bedford e-mail:

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