Summer Enrolment Form 2018

Consent
1. I agree that the representatives of Wilnecote Community Leisure Centre have my permission to
authorise emergency medical treatment (including anaesthetic) should the need arise in the
judgement of the medical authorities and in the event that my child’s designated emergency
contacts cannot be reached.
2. I agree to photographs and/or video being taken of my child during the WHSkids sessions.
3. I agree that my child is allowed to walk home without a responsible adult . I understand that
this will mean WHSKIDS staff will allow my child to leave activities at either 4pm or 5:30pm.
(Please note if your child wishes to leave before this, a member of staff will contact one of the
identified contacts before they are allowed to leave).
Holiday Scheme 2018 Code of Conduct:
All parents/careers are expected to go through the code of conduct with their child/children before arriving at
WHSkids.
Children are expected to behave appropriately and promote a safe, fun and healthy environment through productive
participation. The staff will use a positive approach to discipline and will seek parental support to resolve behavioral
issues if required. Children who remain disruptive may be dismissed from the programme.
As a child on any WHSKIDS Activities Programme, I will:
Show respect to other children and treat them as well as I would like to be treated.
Always respect members of staff, listen to instructions so that I know the rules of the session and follow them.
Respect the rights and beliefs of others with courtesy and consideration.
Communicate in an appropriate manner which means I must not use foul language or gestures, harsh words or
tone of voice.
Conduct myself responsibly. I understand that unwelcome teasing, messing around or other unkind behaviors
are not allowed.
Refrain from deliberately causing bodily harm to other children or staff. I understand that pushing, kicking,
hitting or fighting are not accepted and will not be tolerated.
Use the facility and equipment properly.
Respect the property of others.
Be fully responsible for my actions and understand that irresponsible behaviour will result in disciplinary action.
To be filled in by the child:
I understand and accept the Code of Conduct and will follow it at all times. I understand that I will automatically be
removed from the session for unacceptable behaviour.
Signature:…………………………………………………………………………………… Date:………………………………………………
To be filled in by the parent/carer:
I understand that if my child does not follow the Code of Conduct as agreed he/she maybe removed from the session
and sent home early. I have spoken to my child and they are fully aware of the Code of Conduct and the consequences
of unacceptable behavior.
Signature:…………………………………………………………………………………… Date:………………………………………………
Keeping Records
Please note the information included in this enrolment form will be held by Wilnecote Community Leisure Centre until
the end of the Summer Holiday scheme. The information will then be destroyed unless you agree to us keeping your
details for the sole purpose of allowing us to contact you about future Wilnecote Community Leisure Centre activities.
Please sign in this box if we can keep your information after the Holiday Scheme has ended.
The Wilnecote School
Tinkers Green Road
Tamworth
Staffordshire, B77 5LF
01827 831 333
leisure@wilnecotehighschool.org
Thewilnecoteschool.com/leisure
Wilnecote Community Leisure Centre
Summer Holiday 2018
WHSKids
Monday 23rd July—Friday 24th August
10% discount before or
on Saturday 7th July

WHSKids
Main Scheme Hours
10am—4pm
£12.00
Information
(Ages 8—14, Max Capacity is 60 per day)
Per child
Per day
There are a wide range of fun activities for all
tastes and abilities. Each day is split into four
sessions, within each, there is a choice of
activities which can include a daily swim,
benchball, Swedish longball, football, unihockey,
arts and crafts, quizzes, dance routines, drama
games, trampoline coaching, inflatable sessions
and more!!
Extended AM or PM Hours
8:30am—4pm OR 10am—5:30pm
£15.00
Per child
Per day
Sessions are supervised by DBS checked staff.
Participation is flexible as participants could
attend the whole scheme or single days etc,
whatever suits you!
Full Extended Hours
8:30am—5:30pm
£17.00
Per child
Per day
How to Book Your Place:
1. Complete the enrolment form on the opposite page then read and sign the sections on
the back.
Please Note activities are dependent on a minimum and maximum number attending so places cannot be guaranteed.
2. Bring the completed enrolment form into the Leisure Centre along, with payment to
confirm your place. For bookings over £100 a 20% deposit can be made. A payment plan
for the balance will then be agreed.
Please Note the Leisure Centre is open from 4pm each weekday and 9am until 5pm at weekends, it is not possible to pay outside
of these times without making prior arrangements.
3. Relax knowing the summer holidays are taken care of!
10% OFF when bookings are made on or before Saturday 7th July 2018
Come and visit us on Saturday 7th July out on the field for the Community Fun Day!
It’s the ideal time to check if our scheme is right for you and speak to the staff delivering the
scheme.
Any booking made on or after Sunday 8th of July will be charged at the full cost with only a
10% Sibling Discount available to the second and any additional siblings from the same family.
Summer WHSKids 2018: Enrolment Form
Childs Name: Preferred Name:
Address:
Contact Number: Postcode:
Email Address:
Age: Date of Birth:
School Attended:
Emergency Contact 1 Emergency Contact 2
Name: Name:
Relationship to Participant: Relationship to participant:
Contact Number: Contact Number:
Doctors Name:
Surgery: Contact Number:
Does your child have any known medical conditions or allergies? Yes/No
If Yes, please explain:
Is your child currently taking any prescribed medication? Yes/No
If Yes, please explain:
Is there anything else you would like the Holiday Scheme staff to know?
Date and Scheme Selection:
On the days you wish to attend choose which scheme you would like to attend using the following code.
AM - for Extended Am Scheme
M - for Main Scheme
PM - for Extended PM Scheme
E—for full Extended Scheme
Week Dates
WHSKIDS
Monday Tuesday Wednesday Thursday Friday
Amount
paid
Receipt
num/date
Staff
member
E.g 23rd July until 27th July E AM M E PM
1 23rd July until 27th July
2 30th July until 3rd August
3 6th August until 10th August
4 13th August until 17th August
5 20th August until 24th August