Child's name (required)

1st Parent/carer's name (required)

Mrs.Ms.Miss.Mr.Dr.

2nd Parent/carer's name (required)

Mrs.Ms.Miss.Mr.Dr.

Child's date of birth (required) (YYYY-MM-DD)

Address of child's residence (required)

Post Code (required)

Address of parent/carer's residence if different to child

Post Code

Telephone contact information:
Home:
Work:
Mobile:

Email address:

Any special requirements or information we should know?

By submittting this form, I/we hereby enter into the agreement that the above child is to attend Rebecca's Holiday Club during the February Half Term Holidays, 18th - 22nd February 2019

All day session (7:30am - 6:00pm) £34.75

Morning Sessions (7:30am - 12:30pm) £23.25

Afternoon sessions (12:45pm - 6:00pm) £23.75

Please select which session you would like to book on which days:

Monday 18th February 2019: All dayMorning sessionAfternoon session

Tuesday 19th February 2019:All dayMorning sessionAfternoon session

Wednesday 20th February 2019:All dayMorning sessionAfternoon session

Thursday 21st February 2019: All dayMorning sessionAfternoon session

Friday 22nd February 2019: All dayMorning sessionAfternoon session

Rebecca's reserve the right to withdraw its services if any fees remain unpaid for
more than 1 day.

Please make a £10, non-refundable, deposit to register your child's place by either:
1) making a BACS payment to TJHP Ltd T/A Rebecca's out of school club sort code 30-92-94 account number 02514205 or,
2) sending a cheque made payable to Rebecca's Out Of School Club to Rebecca's Out Of School Club, 34 Valley Road, Chandlers Ford, SO53 1GP.
Fees are required, in full, on or before the first day of attendance.

Tick to indicate your agreement to comply with Rebecca's Holiday Club policies and procedures.
I have read and comply with Rebecca's policies and procedures.

Have you submitted your Child Information form?
I have completed a Child Information Form.

Have you submitted your Parental Permission form?
I have completed a Parental Permission Form.

Signature (Please type your name):

Date YYYY-MM-DD: