Archbishop Courtenay 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 Summer 2026

Archbishop Courtenay Primary School - starts Monday 27 July 2026 for 20 days ending Thursday 27 August 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?
Does your child have any medical needs?
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?
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?
Do you give permission for your child to be photographed and for these to be published online?
Do you give permission for your child to take part in activities provided by an approved contractor?
Children must not bring mobile phones or other valuables
Are you a Golding Homes resident?
Is this young person a young carer?
If yes, are they registered with school, Imago/Kent Young Carers, or another organisation (please provide details)?
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. All payments are NON-REFUNDABLE.

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

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
Should be Empty:

Schools Out Holiday Club Summer 2026

Your details

Your child's details

Emergency contact

Please select the dates you want your child to attend

Click the dates below to book and pay for your place. All payments are NON-REFUNDABLE.

Declaration