Online Booking Form
Holiday Club
Child's Name
*
First Name
Middle Name
Last Name
DOB
*
-
Day
-
Month
Year
Date
Does your child have any additional needs?
*
Please give as much detail as possible
Current school/Pre-school
*
Breakfast club (8.00 am to 9.00 am)
Breakfast Club 8 am - 9 am
Tuesday 17th February
Wednesday 18th February
Thursday 19th February
Morning (9.00 am to 12.30 pm)
Morning 9 am - 12.30 pm
Tuesday 17th February
Wednesday 18th February
Thursday 19th February
Extended morning (12.30 pm to 1.30 pm)
Lunch 12.30 pm - 1.30 pm
Tuesdy 17th February
Wednesday 18th February
Thursday 19th February
Afternoon (12.30 pm to 3.30 pm)
Afternoon 12.30 pm to 3.30 pm
Tuesdy 17th February
Wednesday 18th February
Thursday 19th February
Late collection (4.00 pm)
Afternoon 3.30 pm to 4.00 pm
Tuesdy 17th February
Wednesday 18th February
Thursday 19th February
Parent's Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
County
Postal code
Parent's Name
*
First Name
Last Name
Address (if different)
Street Address
Street Address Line 2
City
County
Postal code
Email
example@example.com
Phone Number
*
-
Area Code
Phone Number
Allergies/intolerances
*
Medical/Medications
*
GP Surgery
*
Surgery Name
GP Name
GP Address
Street Address
Street Address Line 2
City
County
Postal Code
Additional information
I understand that a non refundable deposit of £25 is payable. You will receive an invoice via email. No refunds are given for illness or missed sessions.
*
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09-06-66 42210524 Caterpillars Montessori Ltd
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Deposit paid via tax free childcare vouchers
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Last Name
Credit Card Number
Security Code
Card Expiration
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