Monday 24th July – Thursday 31st August 17
Please complete a separate form for each child. Return the completed form to reception by 4pm on the day prior to which your child is to attend. Please Note: We can only accept up to 60 children per day, so early booking is essential to secure your child’s place. We are unable to take bookings on the day.
Sessions are 8.30-4pm (optional stopover available at additional cost)
PLEASE COMPLETE ALL SECTIONS OF THIS APPLICATION FORM
Child’s Name (in full): ______Age: ______
Child’s Address: ______
______Post code: ______DOB: ______
Child’s Religion: ______Child’s Ethnic Origin: ______
Child’s First Language Spoken at Home: ______
School Child attends ______Current School Year______
Parents/Guardians Name: ______Home Phone No: ______
Names of Legal Contacts: ______
(Normally the names of parents/guardians if no court order is in place)
Address of legal contact:
______Postcode: ______
E-mail address ______
Emergency Contact Name: ______Emergency No. ______
Doctor’s Name ______Doctor’s Phone No. ______
Password for signing child out ______
Terms and Conditions
- Gravesham Community Leisure Limited reserves the right to withdraw or change any programmed Acorn Club activity.
- Acorn Club fees are payable upon booking and are not refundable unless a doctor’s certificate for hospitalisation is produced. An administration fee will be deducted.
- A suitable adult must register each child each morning with a password; this password must be used for collecting the child at the end of the session.
- If someone other than the parent/guardian will be collecting the child you must make contact with the Acorn Manager to advise who is collecting and ensure the responsible adult collecting has the password. You will be asked to verify the password to the Acorn manager when making contact.
- A signed letter of consent is required for children walking home alone.
- Application forms must be completed fully for each child when booking, including details of special needs, allergies and ailments.
- Applications will only be accepted up to 4pm the evening prior to the session required.
- A child should have had their fifth birthday, but not their fourteenth birthday on attending an Acorn Club session.
- A child must be collected no later than half an hour at the end of each Acorn Club session or Social Services will be informed, as governed by our registration guidelines.
- Gravesham Community Leisure Limited reserves the right to refuse entry to any child and will require the child to be collected should their behaviour be deemed unacceptable.
- GCLL takes no responsibility for any property lost or stolen.
- I consent to emergency medical treatment being sought as necessary.
- Please provide suitable clothing including coat, bad weather clothes (wellies etc) sunhat and apply waterproof sun cream prior to arrival. Spare clothes may be necessary.
- Mobile phones, tablets and cameras are not permitted; if one of these devices are bought in they will be held in a safe until collection at the end of the day.
- All our policies are available online at or please speak to the Acorn Manager for a copy.
I agree to abide by the terms and conditions.
Signed Parent/Guardian
______
Name in Capitals: ______Date: ______
The following activities could be included in the Acorn Club programme. If you do not wish your child to participate in any of the activities for medical reasons, please DELETE.
SwimmingAbility (swimmer/non swimmer) ______
Bouncy Castle
Trampolines (only with qualified coach)
Ball Sports/Games
Golf
Arts & Crafts
Outside Areas
Park Area (Cascades only)
Quiet Area
Face Painting
Parties
Promotional Photos for advertising
Obstacle Course
Games
Mini Railway (Cascades only)
Coaching Courses e.g. Martial Arts, Fencing (only with qualified coach)
Badminton
Football
Dance (with qualified coach)
Go Karts
Allergies/Dietary requirements (please state) ______
Special needs (e.g. autism, ADHD, etc.,)______
Please make Acorn staff aware of any concerns
Medication: ______
Ailments: ______
Please ensure your child comes with a hat and sun cream
Child Inclusion form. (special needs/ illness/ disability)
Please help us by providing as much information about your childs special needs/ illness/ disability as you can. This will allow us to work with your family to create an inclusion plan tailored to your child’s needs. This may mean that in certain circumstances support from a family member or personal assistant may be required. Each child’s needs, will be assessed on an individual basis. Further information can be added at the bottom of this form.
Can My Child…….
YES / NO / CommentsDress/ undress his or her self before and after swimming?
Cope with loud noises and changes with light and audio differences throughout the centre?
Safely walk as part of a group through the centre and through outside areas.
Take part in group/ team activities?
Understand and follow simple instructions?
Feed his or her self?
Use verbal communication?
Use the toilet independently?
Take any prescribed medication independently?
Swim competently?
Is my Child likely to……..
YES / NO / CommentsRun off?
Display forms of challenging/ aggresive behaviour?
Need a quiet calm area?
Need additional support at times?
Need at least one on one support?
Communicate in alternative languages/ formats?
Further information…….
DATES /
MON
/ AM / PM / S/O /TUE
/ AM / PM / S/O /WED
/ AM / PM / S/ /THU
/ AM / PM / S/O /FRI
/ AM / PM / S/O7th August – 11th August
MAGIC / 7th Aug / 8thAug / 5pm
6pm / 9th Aug / 5pm
6pm / 10th Aug / 5pm
6pm / 11th Aug / 5pm
6pm
Breakfast Club / YES/NO / YES / NO / YES / NO / YES / NO / YES / NO
LUNCH / YES/NO / YES / NO / YES / NO / YES / NO / YES / NO
DATES /
MON
/ AM / PM / S/O /TUE
/ AM / PM / S/O /WED
/ AM / PM / S/ /THU
/ AM / PM / S/O /FRI
/ AM / PM / S/O24th July – 28th July
DISNEY & FANTASY / 24th July / 25th July / 5pm
6pm / 26th July / 5pm
6pm / 27th Jul / 5pm
6pm / 28th Jul / 5pm
6pm
Breakfast Club / YES/NO / YES / NO / YES / NO / YES / NO / YES / NO
LUNCH / YES/NO / YES / NO / YES / NO / YES / NO / YES / NO
DATES /
MON
/ AM / PM / S/O /TUE
/ AM / PM / S/O /WED
/ AM / PM / S/ /THU
/ AM / PM / S/O /FRI
/ AM / PM / S/O31st July –
4thAugust
CIRCUS / 31st
July / 1stAug / 5pm
6pm / 2nd
Aug / 5pm
6pm / 3rd Aug / 5pm
6pm / 4th Aug / 5pm
6pm
Breakfast Club / YES/NO / YES / NO / YES / NO / YES / NO / YES / NO
LUNCH / YES/NO / YES / NO / YES / NO / YES / NO / YES / NO
DATES /
MON
/ AM / PM / S/O /TUE
/ AM / PM / S/O /WED
/ AM / PM / S/ /THU
/ AM / PM / S/O /FRI
/ AM / PM / S/O21st August – 25th August
BEACH / 22nd Aug / 23rd Aug / 5pm
6pm / 24th Aug / 5pm
6pm / 25th Aug / 5pm
6pm / 26th Aug / 5pm
6pm
Breakfast Club
/ YES/NO / YES / NO / YES / NO / YES / NO / YES / NO
YES/NO / YES / NO / YES / NO / YES / NO / YES / NO
Pease tick AM & or PM on days & sessions required