North Surrey Afasic
www.afasicnorthsurrey.org.uk
Dunsandle
4 Meadow Road
Ashtead
Surrey
KT21 1QR
. Activity Weeks 2013 - for children with .
.speech, language & communication difficulties.
01372 278718
April 2013
We are now booking for this year’s summer activity weeks.
North Surrey Afasic has run these weeks since 1985 for children and young people who have speech and
language disorders. As usual, our programme provides fun and challenging activities geared to improve and
enhance communication and confidence. Last year we ran a combined Juniors week in place of the previous
Littles and Middles weeks. This year we revert back to three groups: Littles, Middles and Bowles.
Our aims for the weeks are to provide fun-filled activities which enable the children and young people to try
different things; feel comfortable within the group, and build a trusting relationship with their helpers. For this
reason we expect the children to attend the full five days. For example, it is important for the middles group
that the children and their helpers get to know each other in the first two days before they go away for two
nights.
We provide 1-to-1 helpers for the two younger groups. This ensures that each child may participate in all
activities with confidence. We run a children’s club during school term and many of our club helpers also
volunteer for activity weeks, which we greatly appreciate. The other helpers are mainly a mix of speech
therapy students and sixth form students.
We have kept our charges at or below the level of the last two years. The charges cover half the actual cost
and we subsidise the rest from fundraising, plus we keep costs down by extensive use of volunteer helpers.
We do not want a child to miss out on an activity week because of cost, so if payment is a problem, please
contact Malcolm Stuart at the address above or by email to aw2013@afasicnorthsurrey.org.uk
The following pages have short descriptions of the weeks and the application form.
Malcolm Stuart
Chair,
North Surrey Afasic
North Surrey Afasic is a local branch of Afasic, registered charity no. 1045617.
blank page for 2-sided printing
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Afasic Activity Weeks - for children with speech, language & communication difficulties - 2013
“Littles” Week - ages 5 to 7
Monday 29th July - Friday 2nd August 2013
charge £115
example day from littles week
Based at a church hall in Ashtead, the sessions run from
Age guide (at 1/8/2013) 5 to 7 years
10am – 3.30pm each day. This group has
up to 12 children
1-to-1 helpers to supervise and encourage the children. Attendees
The activities are structured around a central theme of Helpers and Leaders
up to 13
colour and planned activities include kids@sport, cooking;
St Giles Church Hall,
swimming at a local infants school; craft and outings - Main venue
Ashtead, KT21 1EJ
including a whole day out on Wednesday. We end the
Leader
Kelly Cross
week with a children’s party.
Kelly Cross leads the week. Kelly has led our “littles”
Charge per child
£115
week for the past three years. Now home with her own
children, she was deputy head at a local pre-school, she has run drama classes in Dorking and organised
activities for the NCT and she worked with autistic children in private care.
“Middles” Week- ages 8 to 11
Monday 5th August - Friday 9th August 2013 (part residential)
charge £175
example days for middles week
This group of children also has 1-to-1 helpers. It is led by
Sally Brockbank for the first time. Sally is a speech Age guide (at 1/8/2013) 8 to 11 years
therapist at a special needs school in Surrey. She has Attendees
up to 12 children
previously helped as a link and team leader on our Helpers and Leaders
up to 14
Middles and Bowles activity weeks. Sally will be assisted
St Georges Church Hall,
by Di Warwick who has previously led many Afasic Main venue
Mon-Tue: (daytime)
Ashtead
Bowles weeks and Middles weeks.
The first two days will be at St. Giles Church Hall in Main venue
Sayers Croft Field
Ashtead. These days run from 10am – 4pm and they are a Wed-Fri: (residential) Centre, Ewhurst
getting-to-know-you time for all, enabling children to feel Leader
Sally Brockbank
confident enough to go away from parents overnight for
Charge per child
£175
perhaps the first time. The group meets before lunch on
Wednesday at Sayers Croft Field Centre and spends two
nights there, leaving on Friday after lunch. Sayers Croft
(www.sayers-croft.org.uk) is at Ewhurst, south west of Dorking. They have a lot of on-site activities with
teaching staff. Planned activities include craft; swimming; barbeque etc. and a day out on Thursday.
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Afasic Activity Weeks - for children with speech, language & communication difficulties - 2013
“Bowles” Week- ages from 11
Monday 5th August - Friday 9th August 2013 (residential)
Tuesday
- group A
- group B
- group C
Wednesday
- group A
- group B
- group C
charge £250
example days for Bowles week
Morning
Afternoon
Canoe II
Canoe II
Ski 1 - main slope
Harrisons Rocks (bus)
Raft - reservoir
Abseil / Lodge Ropes
Morning
Afternoon
Raft - reservoir
Zip Wire / Low Ropes
Climb (E)
Canoe II
Raft - reservoir
Canoe II
We return once more to Bowles Outdoor Centre near
Tunbridge Wells (www.bowles.ac). Here the group
takes part in varied outdoor activities including dry
skiing, abseiling, rock-climbing and canoeing. There is
also the popular talent show evening to look forward to.
Holly Ashby is leading the week for the second year.
She works with the youth justice service in Surrey and
runs our senior Friday Club. We plan to take either two
or three groups of up to eight young people each,
depending on demand and the accommodation options.
Evening
Abseil / Art works
Zip Wire
Pool Canoe
Evening
Individual Choice:
Ski 1 - main slope /
nursery slope
OR Abseil OR Video
OR Zip Wire
Age guide (at 1/8/2013) From 11 years
Attendees
16-24 young people
Helpers and Leaders
9-13
Main venue
(residential)
Bowles Outdoor Activity
Centre, Kent, TN3 9LW
Leader
Holly Ashby
Charge per person
£250
Applying for a place.
If you would like your child to participate in an activity week, please complete the application form and return
it to Malcolm Stuart at the address below, with the deposit of £50 payable to “North Surrey Afasic”. Once
you have been allocated a place the deposit is not refundable. We will of course return the deposit of anybody
who is not allocated a place. If you need another copy of the application form ask us to send you one. Places
are normally allocated on a first-come first-served basis, subject to your child being suitable for our activity
weeks. If demand exceeds the places available we will set up a waiting list.
What Then?
We send out confirmation (or otherwise) of places soon after your application. A detailed programme and a
reminder for the balance due will be sent near the start of July. If you prefer to pay the remainder in
instalments, rather than one bill at the start of July, then contact Malcolm (see below) to arrange this.
Enquiries to:
Malcolm Stuart
Dunsandle
4 Meadow Road
Ashtead
Surrey KT21 1QR
telephone
01372 278718
email
aw2013@afasicnorthsurrey.org.uk
web
www.afasicnorthsurrey.org.uk
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Afasic Activity Weeks - for children with speech, language & communication difficulties - 2013
Application Form – Page 1 – Contact Information
Name of child or
young person
Date of Birth
School / College
School Year Group
or Course
Activity Week
(please circle)
“Littles”
29 July - 2 August
/ “Middles”
/ 5-9 August
Member of Afasic
(please circle)
yes / no
Afasic central office 020 7490 9410
/ “Bowles”
/ 5-9 August
www.afasicengland.org.uk
Helpline 08453 55 55 77 or 0207 490 9420 - open 10.30 am to 2.30 pm Mon-Fri
Parent / Guardian.
Name
Telephone Numbers
email
this will be used to keep you informed about the progress of your application
Address
.Emergency Contact.
Name
Telephone Numbers
.Child’s GP.
Name
Telephone Number
Address
.Photograph.
Please provide a photograph of your child if you can. You can post it with this
form or email it to aw2013@afasicnorthsurrey.org.uk Thank you.
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Afasic Activity Weeks - for children with speech, language & communication difficulties - 2013
Application Form – Page 2 – Information about your child or young person
Name of child or
young person
We ask for this information to gain the best possible understanding about the individual’s needs and
difficulties. We ask you to answer all sections as honestly as possible. Their behaviours, emotions and
difficulties can change from year to year. We are happy to contact you for a confidential discussion if there
are details you don’t want to include below.
We want to look after these young people in the best possible way and we use the information here to help us
do this. We provide this information to the helpers, so it is useful if you include strategies that you find helpful
in particular situations. When we decide which helper will be with each child we want to allocate the pairings
so the children will get as much out of the activity weeks as possible. We need good information to make
good decisions. Feel free to attach anything else that may relevant, such as speech and language reports.
Previous Activity Weeks.
Has she/he been on an Afasic
activity week before? If so, please
circle the most recent one attended?
been before?
yes
2012
juniors
bowles
no
For children new to afasic activity weeks please
provide, if you can, contact details for a
teacher/relevant person at your child's school,
whom we may contact to discuss strategies.
2011
littles
middles
bowles
2010 or earlier
littles
middles
bowles
Name / Position / Contact information
Communication Difficulties.
What kind of speech and language
difficulty does your son or daughter have?
Do they have a medical diagnosis
(e.g. ASD, ADHD)?
Does your son or daughter use any kind
of alternative/augmentative
communication system, e.g. signs,
symbols? If so, please describe.
Abilities.
Can your son or daughter swim?
If not, is she/he happy in water?
Can she/he cope with energetic physical
activity? If not, what help is needed?
Can she/he cope independently with
personal hygiene/self help? (e.g. using the
toilet, washing, dressing, showering etc.)
If no, how much help is needed?
Is there any likelihood of bedwetting
(residential groups only)?
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Afasic Activity Weeks - for children with speech, language & communication difficulties - 2013
Application Form – Page 3 – Information continued
Name of child or
young person
Medical Information.
Has she/he any food allergies or fads?
Please give details.
Has she/he any other allergies, including
sticking plasters, penicillin?
Do they have any other relevant medical
conditions, e.g. asthma, diabetes?
Please give details of any specialised
treatments or recurrent illnesses; any
medication currently prescribed with
dosage information.
Behaviour and Strategies.
How does your son or daughter’s
condition affect their everyday life?
Are there specific situations she/he has
difficulty coping with?
Please describe useful strategies and the
situations where they help.
Other Information.
For Littles & Middles weeks: Do you
think your child would strongly prefer a
male or a female 1-1 helper?
no strong
preference
Details of siblings, pets, hobbies and any
similar information that you want to tell
us.
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female
male
Afasic Activity Weeks - for children with speech, language & communication difficulties - 2013
Application Form – Page 4 – Permissions and Deposit
Name of child or
young person
Emergency Medical Treatment
I agree to my son or daughter receiving emergency medical treatment, including anaesthetic, as considered necessary by
the medical authorities present and I give authority to North Surrey Afasic or an agent on their behalf to consent to such
treatment if any delay to obtain my signature is considered inadvisable by the Doctor or Surgeon concerned.
Please note that sun cream will be applied by the links or leaders when necessary.
Signature (parent/guardian*) ………………………………………………………… Date ……………………………
* participants over 18 can sign for themselves
Photographs
I give my consent to Afasic to take and use photographs of my son or daughter in Afasic publications, promotional
material and presentations without further approval or consent from me.
To add consent to use photos on Afasic web pages, tick this box or type yes. [ ]
Signature (parent/guardian*) ………………………………………………………… Date ……………………………
If you do not wish to give consent, do not sign here
* participants over 18 can sign for themselves
Liability Statement
These Activity weeks are being organised by the North Surrey branch of Afasic, an integral part of the national Afasic
organisation, which is a registered charity (number 1045617) and a company limited by guarantee.
It should be noted that some elements of the activities are adventurous and involve a degree of personal risk, and by
participating in these Activity weeks, this is acknowledged by the leaders, helpers, links, participants aged 18 or over,
and parents on behalf of participants under 18.
North Surrey Afasic checks the risk assessments of the various venues and centres used for the activities and overnight
stays and checks that public liability insurance cover is in place. All of this information is supplied to Afasic's own
insurers, who also have public liability cover of £5 million in place.
North Surrey Afasic takes out a policy extension for the residential weeks that includes holiday cancellation cover. This
is only in force once we take out the policy extension and that is only after we have the names of all attendees. The
cancellation cover does not refund the first £50, i.e. the deposit.
It should be noted that North Surrey Afasic's officers, committee members, organisers, leaders, helpers and links cannot
take personal liability (beyond the responsibility of Afasic as an organisation) for any acts or omissions in relation to
these Activity weeks.
I understand and accept the above liability statement.
Signature (parent/guardian*) ………………………………………………………… Date ……………………………
* participants over 18 can sign for themselves
Payments
Deposit
[ ] I enclose a deposit of £50 for the Activity Week.
(cheques payable to “North Surrey Afasic” please).
Instalments
[ ] tick this box for information on paying
the balance in instalments
Please send the Forms & Deposit to:
Received
Malcolm Stuart
Dunsandle
4 Meadow Road
Ashtead
Surrey
KT21 1QR
Checked
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