Budehave n Co m m u n i ty Leisure May Half Term Holiday A ctivities Contact | Liam Dart: 07974 348 468, Rob Francis: 07813198692, Budehaven Community Leisure: 01288 353714 y a m t s 1 3 ' TUES Activity up Age Gro Time Cost Tumble Tots 1 - 7 Years 10am - 12pm Ball Sports Handball, Volley ball & Bench ball 7 - 12 Years 9.30am - 12pm £5 Kangaroo Kids Ball & Racket Sports Handball, Dodge ball & Bench ball. Tennis, Badminton & Squash 3 - 7 Years 1pm - 4pm £5 Racket Sports Tennis, Badminton & Squash 8 - 12 Years 1pm - 3pm Select £2.20 £3 Please Ensure You Complete Both Sides Of This Form http://www.budehaven.cornwall.sch.uk/community-leisure e n u j t s 1 ' wedS Activity up Age Gro Activity Day A range of activities sports, dance, arts & crafts, plus a nature trail. Children will be divided into age groups. 4 - 14 Years Time Cost Half day 8.30am - 12.30pm or 12.30pm - 5.30pm £12 Whole day 8.30am - 5.30pm £20 Select e n u j d n thurS' 2 Kangaroo Kids Art & Crafts 3 - 7 Years 10am - 12pm £6 Art & Crafts 8 - 12 Years 10am - 12pm £6 12.30pm - 5pm £5 A Variety Of Sports Ultimate Frisbee, 3 - 13 Years Dodge Ball, Crazy Catch, football **If your child is booked on all day make sure they have a drink and healthy packed lunch. All activities unless stated are at Budehaven Community Leisure. Please make cheques payable to: Budehaven Community School. The bookings will not be confirmed until we have received the completed booking form and payment. All bookings should be sent DIRECTLY to: LIAM DART/ROB FRANCIS, BUDEHAVEN LEISURE CENTRE, STRATTON ROAD, BUDE, and CORNWALL, EX23 8AW. FOR QUERIES PLEASE CONTACT: LIAM DART: 07974 348 468 ROB FRANCIS: 07813198692 LEISURE CENTRE: 01288 353714 EMAIL [email protected] Please be aware that if there are insufficient numbers booked on for sessions we will have to cancel sessions. Booking Form Child’s Name: School Year 2015/2016 : (Please Circle) D.o.B: R 1 2 3 4 5 6 7 8 Age: 9 Home Address: Postcode: School Attending: E Mail Address: Telephone – Please provide at least 2 numbers in priority order: Number 1 2 3 Who (name & work/home/mob) MEDICAL INFORMATION & CONSENT Medical conditions / allergies: (i.e. asthma, diabetes) Medication / special requirements ( please attach a further sheet if required): I hereby authorise the appropriate activity staff member to administer the following medication to my child. Medication times and dose: By signing this sheet you are consenting to the details provided in this sheet. I hereby give consent for my child to receive hospital / medical treatment should the need arise. (Please see statement below) I consent to any emergency treatment necessary. I therefore authorise the appropriate activity staff member to sign on my behalf. Any written form of consent required by the hospital authorities should medical treatment be deemed necessary, provided that the delay required to obtain my signature might be considered, in the opinion of the doctor or surgeon, likely to endanger my child’s health or safety. Has your child any additional needs: Will there be a personal assistant attending with your child? Does your child need an assistant to work with them on a 1-1 basis? YES YES NO NO PHOTOGRAPHS / VIDEO & CONSENT I am happy for my children to be photographed and/or videoed when participating in holiday programme activities. (Photos/video may be used to publicise the programme in print or on the web). YES NO Parent’s Signature: Print name: Relationship to child: Date: COLLECTION DETAILS We are concerned for your child’s safety and for peace of mind have taken the following measures. • My child will be picked up by: Relationship to child • My child will not be picked up (e.g. walking/cycling) Should you wish your child to leave without being picked up please send a note with your child to explain this. Please Note: By signing any of the above you are confirming that you have parental consent for the child mentioned above.
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