CHILDREN'S SUMMER CAMPS - Vale Resort

REGISTRATION & PAYMENT FORM
Child’s Name:_________________________________________
Date of Birth:_____________________________Age:_________
Gender:______________________________________________
Address:______________________________________________
_____________________________________________________
________________________ Postcode:____________________
Email Address:_________________________________________
Telephone:____________________________________________
Doctor’s Name/Surgery:_________________________________
Telephone Number:_____________________________________
Religion/Ethnic Origin:__________________________________
How did you hear about us______________________________
Week
Fee (please circle)
†
Members Non-members
22 - 26 July £79 £89
29 July - 2 August
5 - 9 August
12 - 16 August
19 - 23 August
27 - 30 August
£79 £89
£79 £89
£79 £89
£79 £89
£65 £75
Terms and conditions apply. Please ask staff for details.
†Child needs to be a member to qualify for discount.
EMERGENCY CONTACT
Name:___________________________Telephone:_____________
Does your child have any special needs, which the staff may need to be
aware of (e.g allergies, dietary requirements, medical needs etc)
______________________________________________________________
______________________________________________________________
I give consent for the staff of the Vale Resort Children’s Camps and
Sports Xtra to administer first aid to my child.
In the event that my child should become seriously ill whilst in the care of
the Vale Resorts Children’s Camps or Sports Xtra, I give my consent for the
staff to seek suitable medical intervention as appropriate.
I give consent that photographs of my child may be taken during activities
for promotional use. Sunscreen must be applied by parents before camp
begins.
Signed:___________________________________ Date:________________
(Parent/Guardian)
Card Holder’s Name:________________________________
Telephone Number:_________________________________
Amount of Debit:___________________________________
Method of Payment:________________________________
(Please make cheques payable to Vale Hotel Limited)
Card Number:______________________________________
Expiry Date:_______________Start Date:_______________
Issue Number:__________Security Number:_____________
(3 digits on signature strip)
I understand that all payments are non-refundable and authorise
for the above amount to be debited from my account.
Signature of Cardholder:_________________Date:_______