BOOKING FORM and COURSE INFORMATION
17th – 21st August.
5 – 11 year olds.
£30 per day or £125 per week.
Special discount: Michael Hall pupils: £25 per day or £100 per week
The club will run from 9am – 5pm and lunch is included..
If you would like your son/daughter to attend Kidbrooke Kids, please ensure that
you complete the following forms and return them (with payment) to Liz James at
liz.james@michaelhall.co.uk, or by post at Michael Hall School, Kidbrooke Park,
Priory Road, East Sussex, RH18 5JA by Monday 29th June 2015:
 Booking Form
 Medical Questionnaire
 Payment (cheques made payable to ‘Michael Hall School’)
If you are booking for more than one child, please complete separate booking and
medical forms for each child.
Places will be granted on a first come - first served basis. It is vital that you
pre-book a place for each child.
Many thanks,
Liz James
Example activities: bushcraft, pottery, nature trails, pond dipping, cookery, arts &
crafts, team building, sports and outdoor games, singing, orienteering, camp
craft, first-aid.... and many many more!!!
Further information available at www.michaelhall.co.uk/kidbrooke-kids
Booking Form
Please return to Liz James by June 29th 2015.
Child’s name in full:
Child’s age:
Child’s School:
Parents/ Guardian’s name:
Contact numbers:
1)
2)
NB: Email. This is our preferred means of communication, so please ensure you
write your e mail address clearly and correctly! Please state if you need to be
contacted by post.
E mail address:
Address:
Child’s name
Please indicate the days that your son/ daughter wishes to take part in by ticking
the appropriate boxes (including any extra morning or evening sessions (at £5 per
hour):
9am – 5pm Main Holiday Club
9am -1pm Morning Only
th
Monday 17 August
Tuesday 18th August
Wednesday 19th
August
Thursday 20th August
Friday 21st August
By signing this form, you agree to give consent for your child to be photographed
for Michael Hall School and future promotional Kidbrooke Kids Holiday Club
material.
I enclose a cheque for
made payable to ‘Michael Hall School’
Signed by parent or guardian:
Print name:
Date:
If you have any queries, please contact me on:
01342 822275 or e mail: liz.james@michaelhall.co.uk
MEDICAL QUESTIONNAIRE
Child’s name
Child’s date of birth:
Parent or Guardian’s name
Home Address:
Telephone number: 1)
2)
Name of family doctor:
Address:
Telephone number:
Has your child had any of the following? If yes, please give details:
Details
Asthma or Bronchitis
Yes/No*
Heart Condition
Yes/No*
Fits, Fainting or Blackouts
Yes/No*
Severe Headaches
Yes/No*
Diabetes
Yes/No*
Allergies to any known drugs or
Yes/No*
medication
Any other allergies e.g. material, food, Yes/No*
insect bites etc.
Other illness or disability
Yes/No*
Any recent contact with contagious
diseases and infections
Yes/No*
* = Delete as appropriate
 Does your child take any medication that may be required during the Michael
Hall Summer Holiday Club?
Yes/ No *
If yes, please give details:
PLEASE ENSURE THAT YOU BRING ANY MEDICATION WITH YOU ON THE DAY. YOU
WILL BE ASKED TO SIGN IN ANY MEDICATION DURING THE REGISTRATION PROCESS
AND WILL BE REQUIRED TO COLLECT IT WHEN YOUR CHILD IS COLLECTED AT THE
END OF EACH DAY.
 Immunisation status. Has your child received vaccination against Tetanus in
the last 5 years?
Yes/ No *
If yes, please give date:
 Is your child receiving medical treatment of any kind either from your family
doctor or Hospital?
Yes/ No*
If yes, please give details:
 Has your child been given specific medical advice to follow in an emergency?
Yes/ No*
If yes, please give details:
 Does your child have any specific dietary requirements?
Yes/No*
If yes, please give details:
I CONSENT TO ANY EMERGENCY MEDICAL TREATMENT NECESSARY DURING THE
SUMMER HOLIDAY CLUB AT MICHAEL HALL SCHOOL.
Signed:
Print name:
Date: