Holiday Club Booking Form

Holiday Club Sign up

Details of Attendee

Name of child

Date of birth

Address (Including postcode)

Address

Town

Postcode

Any medical conditions

Dietary needs (Including any allergies)

Any additional information we should be aware of

Details of Parent or Carer

Parent/Carers name

Phone number

Emergency Contact

Emergency contact name (we will contact parent/carer first)

Emergency contact phone number

Dates Attending

Monday, 22nd December 1.30 p.m. to 4 p.m.

Tuesday 23rd December 1.30 p.m. to 4 p.m.

Monday, 29th December 1.30 p.m. to 4 p.m.

Tuesday 30th December 1.30 p.m. to 4 p.m.

Is your Child on Free School Meals

Checkbox Field

Yes

Consent

Do you give consent for your child to receive the necessary First Aid Treatment?

Yes

Photo Consent

I consent to my child being photographed while involved in Yellow Door (Canvey Island Youth Project) activities. These may be used in displays and to promote the charity, on websites and social media.

I do not consent to my child being photographed while involved in Yellow Door (Canvey Island Youth Project) activities.

I have read and agree to the Date and Privacy Information below

Paper forms will be kept in a locked cabinet. Membership forms and session registers will also be kept electronically. We will share this information with Essex Youth Service. This data will only be used internally by Essex Youth Service and will not be shared with any other organisation by them. If you are booked onto holiday clubs, your data will also be shared with the Active Essex HAF Programme, our funding partners for the holiday programme. If you would like to see their privacy information, please let us know. The only other time we will share your information or your child’s will be when we are legally obliged to do so, e.g., for safeguarding, or when you give us specific permission. We will use your information • To contact you and your children about the club or activity • To let you and your child know about other Yellow Door clubs and activities. • To let you know about any fundraising events we may be holding. If you would prefer us not to contact you about other activities and/or fundraising events please let us know.