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?
My Products
*
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next
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Monday 22nd December 2025
£
15.00
Quantity
1
2
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9
10
Tuesday 2rd December 2025
£
15.00
Quantity
1
2
3
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7
8
9
10
Monday 29th December 2025
£
15.00
Quantity
1
2
3
4
5
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7
8
9
10
Tuesday 30th December 2025
£
15.00
Quantity
1
2
3
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5
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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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