The Hide Away The Hide Away

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					The Hide Away
                                          School
(After School Club of Summerswood Primary School)
Furzehill Road
Borehamwood
Hertfordshire
WD6 2DW

Tel:   07922 012070                                                             Club Manager: Mrs C Tarleton




                                    BOOKING FORM
 *** Booking must be made in advance and, at the latest, by 10.30am on the day required ***
Name of Child                                                  Date of Birth

Address                                                        Home Telephone




Name of Parent                                                 Relationship to Child

Emergency Contact                                              Emergency Contact
Name and No. (1)                                               Name and No. (2)

Child’s Medical
Conditions and/or
Allergies and/or any
additional needs
Name of Child’s GP                                             Address of GP



GP Telephone No.


After School Club
Dates Required



After School Club                     Until 4.30 pm                                Until 5.30 pm
Sessions Required
(See overleaf for
fees payable)
Payment Method                             Cash                                         Cheque
HOSPITAL TREATMENT CONSENT:
In the event of an emergency, if The Hide Away staff are unable to contact me, I give my consent for my child
to be taken to hospital for treatment. I agree to my child receiving emergency medical treatment, including
anaesthetic, as considered necessary by the medical authorities present. I authorise The Hide Away staff
member to sign, on my behalf, any written form of consent required, if the delay to obtain my signature is
considered inadvisable by the doctor or surgeon concerned.

Parent’s signature _______________________________________                        Date: _________


       *** PLEASE TURN OVER AND COMPLETE BOOKING FORM INFORMATION ***
                                           CHARGES:
Until 4.30 pm                      £5.00
Until 5.30 pm                      £9.00
Collection from Monksmead School   £1.50

Total Payment Enclosed


       PLEASE REMEMBER THAT PAYMENT MUST BE MADE AT THE TIME OF BOOKING

Please note that good time keeping is very important to the management and organisation
of the club. If you are late to collect your child/children on any occasion, you will be
charged a penalty charge of £5 for each 10-minute period after your booked collection
time.

				
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posted:8/24/2011
language:English
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