Please Confirm
I confirm that my Child attends St.Lukes Halsall Primary School
PARENT / GUARDIAN NAME
Phone Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Post Code
Email
*
example@example.com
Child Name
*
First Name
Last Name
CHILD AGE
*
CHILD Date of Birth
*
-
Month
-
Day
Year
Date
ALLERGIES
*
Please Select
NO KNOWN ALLERGIES
MY CHILD HAS ALLERGIES (Please note them below)
PLEASE TELL US ABOUT YOUR CHILDS ALLERGIES?
DOES YOUR CHILDS HAVE ADDITIONAL NEEDS?
*
Please Select
NO
YES
PLEASE TELL US ABOUT YOUR CHILDS ADDITIONAL NEEDS?
SELECT YOUR CAMP DATES (for full week with a discount, please select the last option)
*
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next
( X )
Monday 27th October 2025
£
20.00
Quantity
1
2
3
4
5
6
7
8
9
10
Tuesday 28th October 2025
£
20.00
Quantity
1
2
3
4
5
6
7
8
9
10
Wednesday 29th October 2025
£
20.00
Quantity
1
2
3
4
5
6
7
8
9
10
Thursday 30th October 2025
£
20.00
Quantity
1
2
3
4
5
6
7
8
9
10
Friday 31st October 2025
HALLOWEEN DISCO (OPTIONAL DRESS UP)
£
20.00
Quantity
1
2
3
4
5
6
7
8
9
10
FULL WEEK - Mon 27th October to Fri 31st October
£
70.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
CAN YOUR CHILD BE ON SOCIAL MEDIA?
*
Please Select
YES
NO
Submit
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