Personal Details


SNAAP BOOKING FORM – February half term 2018

Parent / Carer Name / Email
Home Contact No. / Address
Mobile Contact No.
Childs Name / Childs
Age / Details of Disability / Wheelchair
User (Y/N)

Booking Details

Trip / Event / Date / Ages / No. of
Carers / No. of
disabled
children / No. of
add.
children / No. of
add.
adults / Cost / Total
Cost
Film club – Emoji / Tues 13th Feb / All / Free
*Lunch box / All / £1 per child
*Dietary needs
Play Zone / Sun 11th Feb / All / £8.50 per child
*Dietary needs
Buzz Club 8-15yrs
*MUST complete / Wed 14th Feb / 8-15 years / £10.00 each
Fri 16th Feb / 8-15 years / £10.00 each
Chill Zone 16-25yrs
*MUST complete / Tues 13th Feb / 16 - 25
years / £10.00 each
Thurs 15th Feb / 16 - 25
years / £10.00 each
Total cost
*FOR BUZZ CLUB and CHILL ZONE ONLY – must be completed to be offered a place*
School/college
attended / Does your child have an EHCP or Statement of
SEN? / Yes / No
Allocated Social
Worker’s name / Does your child attend a special school or in
a unit attached to a mainstream school? / Yes / No

Payment

I have paid in full
I have paid by BACS payment (please pay into our bank using the following details) Sort Code – 309961
Account – 15794968
Reference to be – your name
Buzz Club – I have enclosed a Care Plan (only required if not sent previously) Please note: Your child will not be offered a place without this.
OFFICE USE ONLY / Amount Paid £ / Cash / Cheque / Signed / Date / /

Thank you for booking on an event. If you have an idea for a trip / event please email