Playscheme Booking Form

December Play Scheme
Information & Booking Form

Time 10am – 3pm • Cost £20 per day (unless otherwise stated) • Party £10

Which scheme is right for my child?

Main play scheme will run from Kids Can Achieve at Pinner Green and is for all our children up to the age of 12 years. Places are limited due to lack of space so please request 2 days in the first instance and advise us of any additional days you would like if we have availability.

High Achievers scheme will run from St Peters Church, Colbeck Road, Harrow, HA1 4BX. It aims to provide a safe place to play and explore through a structured environment to progress their social, independence and speech and language skills. Activities include drama and cooking, groups are limited to 12 children a session.

Older Less Able – Will run from KCA at Pinner on 20th and 23rd December; one day at St Peters if possible.

Youth Group (12-19 year olds) run a series of trips and activities aimed at providing young people with safe but exciting activities. We allow young people to develop independence and socialise with peers.

Please send your child to playscheme daily with
o A suitable packed lunch
o Spare clothes
o Nappies and wipes if necessary
o Medication if necessary in original labelled container (this must be given to Manager when you arrive).
o Swimming kit

We would like to ask parents to provide this in 1 strong suitable bag like a 'bag for life'. The bag should be labelled with your child’s name to enable their key worker to keep all your child’s belongings together, as they do sometimes get misplaced and mixed up on pegs.

Booking forms need to be in by Monday December 12th at the latest. We cannot accept any bookings after this date.

We have recently been having problems of non – attendance at play scheme, therefore we can now no longer accept bookings without full payment. If your child cannot attend we need 24hours notice or you will still be charged for the place.

Kind regards

Julie Browne
Chief Executive

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Booking Form

Name of child................................................................................................Date of birth.............................

Address and telephone number.....................................................................................................................

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Ethnicity ........................................................................

Please circle the sessions that you would like your child to attend play scheme:

Week 1

	Mon 19th	Tue 20th	Wed 21st	Thur 22nd	Fri 23rd
Main Scheme (under & over 8s)	10-3	Willows Farm Trip (additional cost £20)	10-3	Christmas Party Greenwood Hall 3-6pm	No service
High Achievers (St Peter's Church)	No service	Willows Farm Trip (additional cost £20)	10-3	9.30-2.30 (then Christmas Party at Greenwood)	No service
Older / Less Able (KCA)	No service	10-3	No service	Christmas Party Greenwood Hall 3-6pm	10-3
Youth (meet at KCA)	Cinema, snack and lunch 10-4 £15	Bowling and lunch 10-4 £15	No service	Christmas Party Greenwood Hall 3-6pm	No service

Week 2

	Mon 26th	Tue 27th	Wed 28th	Thurs 29th	30th
Main Scheme (under & over 8s)	No service	No service	10-3	10-3	10-3
High Achievers (St Peter's Church)	No service	No service	No service	No service	No service
Older / Less Able (KCA)	No service	No service	No service	No service	No service
Youth (meet at KCA)	No service	No service	Quasar and lunch 10-4 £15	London Eye and dinner 3-9pm £20 (limited spaces)	No service

Please provide 2 emergency contact numbers and their relationship to child e.g. grandmother

1...................................................................................................................................................................

2...................................................................................................................................................................

In the event of an accident and the parent guardian being unavailable we will consent to treatment and medication advised by qualified medical professions. I am aware my child may also travel in staff cars, coach or minibus.

Signed .....................................................................

Details of any allergies or medication, diet etc

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GP name and phone number

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Other important information including swimming ability

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How will your child's place/s be funded. Please indicate the number of days funded by each source.

Children with Disabilities Team	Short Breaks Fund (Aiming High)	Parent
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Name of social worker (if applicable) ..........................................................................................................

Do you receive disability living allowance (DLA) for your child? If so please indicate the rate you receive for care and / or mobility components?

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