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 / Comments
Dress/ 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 / Comments
Run 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/O
7th 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/O
24th 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/O
31st 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/O
21st 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

S/O = Stop over please tell us your pick up time (up until 6pm) ______

Breakfast Club or Lunch please circle the YES or NO