Blossom in the Forest Holiday Camp Summer holidays

Name of child/children......

Please complete the form using block capitals and return to Little Blossoms Nursery School – (or post to 81 bloomfield drive ba22bh)

Cost: £35 per day 8am-5pm

Monday
Tuesday
Wednesday 25th July
Thursday 26th July
Friday 27th July
Monday 30th July
Tuesday 31st July
Wednesday 1st Aug
Thursday 2nd Aug
Friday 3rd Aug
Monday 6th Aug
Tuesday 7th Aug
Wednesday 8th Aug
Thursday 9th Aug
Friday 10th Aug
Monday 13th Aug
Tuesday 14th Aug
Wednesday 15th Aug
Thursday 16th Aug
Friday 17th Aug

Parent/Carer details: Child Details:

Name ...... First Name ......

Address ...... Surname ......

...... Male/Female ......

Postcode ...... Date of Birth ......

Home Tel No ...... Age ......

Mobile ...... School Attended ......

Work No ......

Email address ……………………………...... Attended before? Yes/No ....

Emergency contacts – Names/Tel Nos .... Any special friends at Blossom in the forest? ......

1......

2...... (helpful to know when making groups)

Child Medical Details:

Name of Doctor ...... Practice ......

Details of any medical conditions/known allergies ......

......

Details of Treatment required In the event of sudden illness or accident affecting my child, if recommended by a doctor, I agree to emergency treatment including any operative and/or administration of a general anaesthetic to my child.

I give/do not give consent for staff to apply sunscreen / arnica cream/ Waspeze if needed I give/do not give consent for photographs.

I have read the Terms and Conditions of Booking and agree to abide by them.

Signed: ...... Date ......

I enclose a fee of £ ......

Booking must be accompanied by payment, otherwise booking cannot be guaranteed. Cheques made payable to Little Blossom Nursery School.

Terms and conditions of Holiday Club: 1. A place is onlyconfirmed oncepayment is received.

2. Please note that we are unable to offer any refund of fees if your child is unable to attend through sickness or any non-attendance.

3. Any additional trips will be charged separately.

4. All unscheduled LATECOLLECTIONS incur a £15.00 per 15 minute charge or part thereof.

We do accept Childcare vouchers. Please advise us in advance if you are using vouchers. Payment can be made by cheque, cash or BACS (details below) but not credit/debit card.

PLEASE PUT YOUR CHILDS NAME AS PAYMENT REFERENCE

Natwest – Little Blossoms Nursery School

Sortcode- 60-24-37

Account number 20925131