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Child’s Name
School attended Year Class
Age Male Female (please tick) Date of Birth (dd mm yyyy)
Address
Post Code
Tel. No. 1 Tel. No. 2
Person collecting your child* *You must inform AKTIVA CAMPS of any change to this named person
Who has legal contact with the above named child(ren)?
Who has parental responsibility for the above named child(ren)?
Name of G.P. G.P.’s Tel. No.
G.P.’s Address
Co
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Info
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In the event of __________________________ (full name of child) requiring medical or surgical treatment, including the administration of local or general anaesthetics in any emergency during his / her stay at AKTIVA CAMPS, I hereby give my consent to such treatment as may be considered necessary by a registered medical practitioner.
X Signed (Parent/Guardian)Med
ical
Em
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£Amount
Pay
men
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I will pay via childcare vouchers.
Provider£Amount
Debit or credit card payments can be processed through our accounts department, by calling 020 3551 8909. (Please note for credit card payments there is an additional 2% charge).
I will pay the full amount via bank transfer. Account Name: Aktiva Camps Ltd Bank: HSBC Plc Account No: 11402250 Sort Code: 40-05-09
By signing this booking form, you agree to the terms and conditions on the Aktiva Camps Ltd websitewww.aktivacamps.com
Co
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& S
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Please give your consent for us to use plasters in the event that your child has a minor injury. Please give your consent for us to use cleansing wipes were deemed necessary. Please give your consent for us to supply your child with sun cream that they will apply to themselves in hot weather. Please give your consent for us to support your child in changing their clothes in the event of them becoming
wet or soiled due to an accident or during water or messy play.
Please return completed booking form to:Aktiva Camps Ltd, 1 Lyric Square, London, W6 0NB
Building confidence and broadening experience!www.aktivacamps.com
Tel: +44 (0)20 3551 8909Email: [email protected]
Date
During their stay at the camp, will your child have any:
Medical requirements? (e.g. asthma) YES NO
Dietary requirements? YES NO
Special educational needs or disability? YES NO
If YES to any of the questions to the left, please attach additional information.
X Signed (Parent/Guardian)
No chequesor cash please
Booking FormSummer Holidays 2016
Please complete in BLOCK CAPITALS
Aktiva Camps
@Aktiva_News
Dat
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or
Sum
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Ho
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s 20
16
AKTIVA CAMPS LIMITED1 Lyric SquareLondon W6 0NB
Tel: +44 (0)20 3551 8909Email: [email protected]
Prices & Timings
Please note: These drop off and pick up times are fixed. Unfortunately we are not able to accommodate any changes in these due to our strict staff ratio policy.
Extended day(8.00am– 6.00pm)
£159 / week
£45 /day
Standard day(9.00am– 5.00pm)
£135 / week
£35 / day
Short day(10.00am– 3.00pm)
£125 / week
£25 / day
Belmont
Summer Holidays
Mon Tue Wed Thu Fri
Aug 8 9 10 11 12
Aug 15 16 17 18 19
Aug 22 23 24 25 26
Aug 29 30 31
Sep 1 2
Harvington
Summer Holidays
Mon Tue Wed Thu Fri
Aug 22 23 24 25 26
Mount Carmel
Summer Holidays
Mon Tue Wed Thu Fri
Jul 18 19 20 21 22
Jul 25 26 27 28 29
Aug 1 2 3 4 5
Aug 8 9 10 11 12
Aug 15 16 17 18 19
Aug 22 23 24 25 26
Aug 29 30 31
Sep 1 2
Booking FormSummer Holidays 2016
St John’s Fulham
Summer Holidays
Mon Tue Wed Thu Fri
Jul 21 22
Jul 25 26 27 28 29
Aug 1 2 3 4 5
Aug 8 9 10 11 12
Aug 15 16 17 18 19
Aug 22 23 24 25 26
Aug 29 30 31
Sep 1 2
Little Ealing
Summer Holidays
Mon Tue Wed Thu Fri
Jul 20 21 22
Jul 25 26 27 28 29
Aug 1 2 3 4 5
Aug 8 9 10 11 12
Aug 15 16 17 18 19
Aug 22 23 24 25 26
Aug 29 30 31
Sep 1 2
Sep 5 6
West Acton Primary
Summer Holidays
Mon Tue Wed Thu Fri
Jul 25 26 27 28 29
Aug 1 2 3 4 5
Aug 8 9 10 11 12
Aug 15 16 17 18 19
Aug 22 23 24 25 26
Aug 29 30 31
Sep 1 2
Grange Primary
Summer Holidays
Mon Tue Wed Thu Fri
Jul 25 26 27 28 29
Aug 1 2 3 4 5
Aug 8 9 10 11 12
Aug 15 16 17 18 19
Aug 22 23 24 25 26
Aug 29 30 31
Sep 1 2
= Bank Holiday
