Greenfields May 2026 Schools Out Holiday Club

The Gallagher Stadium,

James Whatman Way,

Maidstone, Kent ME14 1LQ

info@stonesinthecommunity.org

Registered Charity No. 1184274
Schools Out Holiday Club May 2026

Greenfields Community Primary School - Tuesday 26 to Thursday 28 May 2026
Your details
Parent or guardian name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityCounty

Postal / Zip Code
Phone Number*

Area CodePhone Number
E-mail*
example@example.com
Your child's details
Name of your child attending the programme*

First NameLast Name
Date of birth*

DayMonthYear
Date
Child age at start of programme*
Ethnicity*
Gender
School your child attends*
Does your child have an EHCP or HNF or similar (SEND) in place?*

YesNo
Does your child have any medical needs?*

YesNo
If Yes please outline your child's needs below including any support required:
Does your child have any special educational needs EG. ASD, ADHD etc?*

YesNo
If Yes please outline your child's needs below including any support required:
Do you give permission for your child to receive first aid if required?*

YesNo
Do you give permission for your child to be photographed and for these to be published online?*

YesNo
Do you give permission for your child to take part in activities provided by an approved contractor?*

YesNo
Children must not bring mobile phones or other valuables*
Emergency contact
Secondary emergency contact name*

First NameLast Name
Secondary emergency contact phone number*

Area CodePhone Number
Emergency Pick Up Pin (should you not be able to collect them and arrange alternate collection) - four digit number:*
Lunch is not provided and must be brought for every day booked*
Please select the dates you want your child to attend

Click the dates below to book and pay for your place. Payments are non-refundable.

Tuesday 26 May 2026 Schools Out Holiday Club - Greenfields

£5.00

Wednesday 27 May 2026 Schools Out Holiday Club - Greenfields

£5.00

Thursday 28 May 2026 Schools Out Holiday Club - Greenfields

£5.00

Total

£0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Declaration
By signing this form you are declaring that the information provided is correct.

If you do not declare a child's full medical and disability and behaviour needs on this form to take part in the Schools Out Holiday Club it could cause a safeguarding issue for your child, and/or other children in our care. This could result in you being asked to collect your child to prevent this happening in our clubs. It's important we staff appropriately to ensure our staff can meet your child's needs without putting others at risk including our staff.
Signature*
Date*

DayMonthYear
Date
Name*
Additional information
Are you a Golding Homes resident?*

YesNo
Should be Empty:

Schools Out Holiday Club May 2026

Your details

Your child's details

Emergency contact

Please select the dates you want your child to attend

Declaration

Additional information