Christmas Holiday ClubTuesday 2nd to Friday 5th January 2024>Please note that this club is for children in Years 1 to 8 ONLY>Child's Name* First Name Surname / Family Name My child attends the following school*Please enter the name of your child's schoolSchool Year*Please select the CURRENT School Year your child is in12345678Name of Parent/ Guardian* First Name Surname / Family Name Email*Please provide the email address that you would like ALL correspondence to go to.Mobile*Please provide one mobile phone number that you can be contacted on in the event of an emergency during the Holiday Club.Does your child have any medical conditions that we should be aware of?* No Asthma or Bronchitis Severe Allergies requiring an EPI pen Other Allergies OtherDoes your child have any dietary needs that we should be aware of?* No Vegetarian Vegan OtherDoes your child have any SEND needs that we should be aware of?* No Dyslexia ADHD / ADD Autism SEND with 1 - 1 support in school OtherPlease contact us if your child receives 1:1 support in school before completing the booking form.Please give more details of your child's medical, dietary or SEND needs as necessaryIn the event of a minor accident and when I cannot be contacted, I agree for First Aid to be administered by a qualified First Aider.* Yes NoMy child is eligible for benefits related Free School Meals and qualifies for a HAF funded place* No YesIf you answered yes to the previous question please type in your HAF codePlease check your Council's website for how to get a HAF code if you have not received one from your school. Failure to use the correct code may result in you being charged for your child's place.I give my consent for photographs and or film of my child to be used for EKO Ltd. displays incl. internet site and social media* Yes NoI give my consent for photographs and or film of my child to be used for STAFFORDSHIRE / SHROPSHIRE / TELFORD & WREKIN COUNCIL displays incl. internet site and social media* Yes No"Please be aware that photographs / video taken at HAF events, holiday clubs and activities are for promotional purposes and may be used by Staffordshire / Shropshire / Telford & Wrekin County Council"I wish to be kept informed of other EKO Ltd. activities and events.* Yes NoAs the parent/guardian I have read, fully understand and am satisfied with the details supplied regarding EKO Ltd. Club activities and agree for my child to take part in them.*Ticking 'Signed' means you have electronically signed for this. SignedChristmas Holiday Dates 2022Please select the date followed by the appropriate payment option. Please check your HAF eligibility before making a HAF booking.Tuesday 2nd JanuaryPlease select£40 - Long Day - Paypal£35 - Short Day - PayPal£40 - Voucher long day - childcare voucher paid direct by BACS£35 - Voucher short day - childcare voucher paid direct by BACS£5 - HAF long day - PayPal£0 - HAF short day - FreeWednesday 3rd JanuaryPlease select£40 - Long Day - Paypal£35 - Short Day - PayPal£40 - Voucher long day - childcare voucher paid direct by BACS£35 - Voucher short day - childcare voucher paid direct by BACS£5 - HAF long day - PayPal£0 - HAF short day - FreeThursday 4th JanuaryPlease select£40 - Long Day - Paypal£35 - Short Day - PayPal£40 - Voucher long day - childcare voucher paid direct by BACS£35 - Voucher short day - childcare voucher paid direct by BACS£5 - HAF long day - PayPal£0 - HAF short day - FreeFriday 5th JanuaryPlease select£40 - Long Day - Paypal£35 - Short Day - PayPal£40 - Voucher long day - childcare voucher paid direct by BACS£35 - Voucher short day - childcare voucher paid direct by BACS£5 - HAF long day - PayPal£0 - HAF short day - FreeI wish to pay for my child's place using CHILDCARE VOUCHERS* No YesIf you answered yes to the previous question please enter the name of your childcare voucher providerPayPal Payment TotalVOUCHER PAYMENTS ONLY. Please note that this form cannot calculate the total voucher payment to be paid. We will send you conformation of the total to pay for your booking shortly.Billing InformationPlease enter your billing informationFirst Name*Last Name*Email* Please provide the email address that you would like ALL correspondence to go to.Address*Address 2Town/City*County*Postcode*Country*Holiday Club Payment £ 0.00 If you have chosen to pay by CHILDCARE VOUCHERS we will send you confirmation of the payment required shortly.