I wish to pay the full amount via BACS transfer.Account Name: Aktiva Camps Ltd Bank: HSBC Plc Account No: 11402250 Sort Code: 40-05-09
£Amount
I wish to pay via childcare vouchers.Provider
£Amount
I enclose a cheque for made payable to AKTIVA CAMPS. Please use child’ssurname as a reference.
£
Payment Details
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
Contact Information Please complete in BLOCK CAPITALS
www.aktivacamps.com
By signing this booking form, you agree to the terms and conditions on the Aktiva Camps Ltd website (www.aktivacamps.com).
Please send cheque and completed booking form to the School reception or send to:
Ben Douglas, AKTIVA CAMPS LIMITED,500 Chiswick High Road, London W4 5RG
X Signed (Parent/Guardian)
Tel: +44 (0)20 3551 8909Email: [email protected]
Medical Emergency
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.
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? YES NO
If YES to any of the above, please attach additional information.
X Signed (Parent/Guardian)
École André Malraux Booking Form
AKTIVA CAMPS LIMITED
500 Chiswick High RoadLondon, W4 5RGTel: +44 (0)20 3551 8909Email: [email protected]
Aktiva Camps atÉcole André Malraux
44 Laurie RoadHanwell, London, W7 1BL
Ofsted registered EY466213
www.aktivacamps.com
Monday Tuesday Wednesday* Thursday Friday Full week (Monday–Friday)
Start date: ______________________________
No. of days12345
Fees/month £36 (excludes Wednesday) £71 £107 £142 £160
After School Club
Breakfast Club
PLEASE TICK THE DAYS YOU WOULD LIKE TO BOOK:
Monday Tuesday Wednesday Thursday Friday Full week (Monday–Friday)
Start date: ______________________________
No. of days12345
Fees/month £17 £34 £52 £69 £86
10% discount for full week bookings only.
PLEASE TICK THE DAYS YOU WOULD LIKE TO BOOK:
Last Minute + Wednesday Child Care
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£5.00 per session
Monday, Tuesday, Thursday & Friday£15.00 per session
Wednesday*1.30pm–6.00pm £20 per session
PLEASE PROVIDE THE DATES YOU WOULD LIKE TO BOOK:
Are you interested in our holiday camps? Are you interested in our weekend activities? Are you interested in our birthday parties?
Aktiva Camps
@Aktiva_News
École André Malraux Booking Form
www.aktivacamps.com
AKTIVA CAMPS LIMITED
Aktiva Camps
@Aktiva_News
500 Chiswick High RoadLondon, W4 5RGTel: +44 (0)20 3551 8909Email: [email protected]
Open until 6pmMonday to Friday on school sites
Ofsted Registered
Child Care
After school care includes all the sports and activities offered in the after school clubs.
Child Care flyer - All sites.indd 1 05/06/2013 17:43
Enquiry form
www.aktivacamps.com
Child care
PleASe TICK THe DAYS You WoulD lIKe To BooK:
Monday Tuesday Wednesday Thursday Friday Full week (Monday–Friday)
10% discount fullweek booking
No. of days12345
Fees/month £36 £71 £107 £142 £160
Name of child ���������������������������������������������������������������������������������������������������������������������������
School attending ����������������������������������������������������������������������������������������������������������������������
Class ���������������������������������������������������������������������������������������������������������������������������������������
Email address ��������������������������������������������������������������������������������������������������������������������������
Contact telephone number �������������������������������������������������������������������������������������������������������
Last minute child care
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£15.00 per session
PleASe PRoVIDe THe DATeS You WoulD lIKe To BooK:
Breakfast Club
PleASe TICK THe DAYS You WoulD lIKe To BooK:
Monday Tuesday Wednesday Thursday Friday Full week (Monday–Friday)
No. of days12345
Fees/month £17 £34 £52 £69 £86
> Please contact the office to enquire if an Aktiva operated breakfast club is offered at your school.
+44 (0)20 3551 8909
www.aktivacamps.com
Tel: +44 (0)20 3551 8909Email: [email protected]
Child Care flyer - All sites.indd 2 05/06/2013 17:43