UKeff Easter HAF Booking Form Please complete one form per address. You may add up to 5 children to this form as long as they live at the same address. 12345NOTICEBy completing this form you are consenting to sharing your childs details with Oldham Council and the Department for Education. This provision is STRICTLY for children in receipt of BENEFITS RELATED FREE SCHOOL MEALS. For those not receiving benefits related free school meals, there is a charge.ONLY ONE HOUSEHOLD PER BOOKING FORMIf you are registering places for children who live at a different address (eg nieces, nephews), you will need to complete a separate booking form. Do not include children on the same form who do not live at the same address.DEPOSITUKeff requires a deposit to secure the booking of some of the activities. Bookings made without a deposit will not be secured. This deposit will be fully refunded after attendance at the booked activity (for children in receipt of benefits related free school meals).Are you in receipt of any of the following? *Universal CreditWorking Tax CreditChild Tax CreditNone of the aboveDoes your child receive benefits related free school meals? *YesNoIs your child SEND registered? *YesNoNextOLDHAM COLISEUMThe OLDHAM COLISEUM activity is only for participants who have never attended a performance at the Oldham Coliseum Theatre before. By continuing to book this activity, you are confirming this condition. A Β£10 refundable deposit is required per family to book the Oldham Coliseum activity. The deposit will be fully refunded once the activity has been attended by the child/children on the booking form, provided that they are in receipt of benefits related free school meals.HOLLOWFORD CENTREThe HOLLOWFORD CENTRE activity is only for participants who have never attended the Hollowford Centre. By continuing to book this activity, you are confirming this condition. There is a Β£5 deposit per child for the Hollowford Centre activity, capped at Β£10. If you book for more than 2 children for Hollwford within the same booking form, there will be no additional deposits required. The deposit will be fully refunded once the activity has been attended by the child/children on the booking form, provided that they are in receipt of benefits related free school meals.ADULTSOne adult must attend the activity with the child/children booked, with the exception of the Hollowford Centre which is soley for children aged 9 to 16 years.PAYMENT REQUIREDAt the end of this form you will be redirected to make your payment. Your booking WILL NOT BE SECURED until payment has been received. For any problems, please contact us directly at enquiries@ukeff.org or telephone 01616606818PreviousNextBOOKING INFORMATIONTo book an activity, please provide the name of the parent/guardian, and up to 5 children.Full Name of Parent or Guardian *FirstLastAdult's full nameRelationship to child *For example: parent, aunty, grandparentFull Name of Child 1 *FirstLastChild's full nameChild 1 Date of Birth *DD12345678910111213141516171819202122232425262728293031/MM123456789101112/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Please select from the following activities:* 19th April Hollowford Centre, Peak District (age 9+)21st April Iftar and activities, Azmat-e-Islam Mosque, 79 Retford St, 5.30pm - 9.30pm* Β£10 deposit required per family booking for The Jungle Book, Β£5 per child (capped at Β£10) for the Hollowford Centre, refunded upon attendance at the activity. Please note, you will not be charged for additional seats within the same booking.Child 1 School Name and Address *Child's school name and addressChild 1 Medical Information *Details of any medical conditions, illnesses or medications eg. asthma, epilepsyChild 1 Allergies *Details of any allergies, INCLUDING FOOD ALLERGIES (e.g. nuts, kiwi, grains, dairy)Child 1 Ethnicity *SELECT FROM DROP DOWN LISTWHITE BLACK/AFRICAN/CARIBBEAN/BLACK BRITISHASIAN OR ASIAN BRITISH MIXED/MULTIPLE ETHNIC GROUPSOTHER ETHNIC GROUP PREFER NOT TO SAYDo you want to add another child to your booking? *YesNoFull Name of Child 2 *FirstLastChild's full nameChild 2 Date of Birth *DD12345678910111213141516171819202122232425262728293031/MM123456789101112/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Please select from the following activities: * 19th April Hollowford Centre, Peak District (age 9+)21st April Iftar and activities, Azmat-e-Islam Mosque, 79 Retford St, 5.30pm - 9.30pm* Β£10 deposit required per family booking for The Jungle Book, Β£5 per child (capped at Β£10) for the Hollowford Centre, refunded upon attendance at the activity. Please note, you will not be charged for additional seats within the same booking.Child 2 School Name and Address *Child's school name and addressChild 2 Medical Information *Details of any medical conditions, illnesses or medications eg asthma, epilepsyChild 2 Allergies *Details of any allergies, INCLUDING FOOD ALLERGIES (e.g. nuts, kiwi, grains, dairy)Child 2 Ethnicity *SELECT FROM DROP DOWN LISTWHITE BLACK/AFRICAN/CARIBBEAN/BLACK BRITISHASIAN OR ASIAN BRITISH MIXED/MULTIPLE ETHNIC GROUPSOTHER ETHNIC GROUP PREFER NOT TO SAYDo you want to add another child to your booking? *YesNoFull Name of Child 3 *FirstLastChild's full nameChild 3 Date of Birth *DD12345678910111213141516171819202122232425262728293031/MM123456789101112/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Please select from the following activities: * 19th April Hollowford Centre, Peak District (age 9+)21st April Iftar and activities, Azmat-e-Islam Mosque, 79 Retford St, 5.30pm - 9.30pm* Β£10 deposit required per family booking for The Jungle Book, Β£5 per child (capped at Β£10) for the Hollowford Centre, refunded upon attendance at the activity. Please note, you will not be charged for additional seats within the same booking.Child 3 School Name and Address *Child's school name and addressChild 3 Medical Information *Details of any medical conditions, illnesses or medications eg asthma, epilepsyChild 3 Allergies *Details of any allergies, INCLUDING FOOD ALLERGIES (e.g. nuts, kiwi, grains, dairy)Child 3 Ethnicity *SELECT FROM DROP DOWN LISTWHITE BLACK/AFRICAN/CARIBBEAN/BLACK BRITISHASIAN OR ASIAN BRITISH MIXED/MULTIPLE ETHNIC GROUPSOTHER ETHNIC GROUP PREFER NOT TO SAYDo you want to add another child to your booking? *YesNoFull Name of Child 4 *FirstLastChild's full nameChild 4 Date of Birth *DD12345678910111213141516171819202122232425262728293031/MM123456789101112/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Please select from the following activities: * 19th April Hollowford Centre, Peak District (age 9+)21st April Iftar and activities, Azmat-e-Islam Mosque, 79 Retford St, 5.30pm - 9.30pm* Β£10 deposit required per family booking for The Jungle Book, Β£5 per child (capped at Β£10) for the Hollowford Centre, refunded upon attendance at the activity. Please note, you will not be charged for additional seats within the same booking.Child 4 School Name and Address *Child's school name and addressChild 4 Medical Information *Details of any medical conditions, illnesses or medications eg asthma, epilepsyChild 4 Allergies *Details of any allergies, INCLUDING FOOD ALLERGIES (e.g. nuts, kiwi, grains, dairy)Child 4 Ethnicity *SELECT FROM DROP DOWN LISTWHITE BLACK/AFRICAN/CARIBBEAN/BLACK BRITISHASIAN OR ASIAN BRITISH MIXED/MULTIPLE ETHNIC GROUPSOTHER ETHNIC GROUP PREFER NOT TO SAYPleaase select which option you identify with.Do you want to add another child to your booking? *YesNoFull Name of Child 5 *FirstLastChild's full nameChild 5 Date of Birth *DD12345678910111213141516171819202122232425262728293031/MM123456789101112/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Please select from the following activities: * 19th April Hollowford Centre, Peak District (age 9+)21st April Iftar and activities, Azmat-e-Islam Mosque, 79 Retford St, 5.30pm - 9.30pm* Β£10 deposit required per family booking for The Jungle Book, Β£5 per child (capped at Β£10) for the Hollowford Centre, refunded upon attendance at the activity. Please note, you will not be charged for additional seats within the same booking.Child 5 School Name and Address *Child's school name and addressChild 5 Medical Information *Details of any medical conditions, illnesses or medications eg asthma, epilepsyChild 5 Allergies *Details of any allergies, INCLUDING FOOD ALLERGIES (e.g. nuts, kiwi, grains, dairy)Child 5 Ethnicity *SELECT FROM DROP DOWN LISTWHITE BLACK/AFRICAN/CARIBBEAN/BLACK BRITISHASIAN OR ASIAN BRITISH MIXED/MULTIPLE ETHNIC GROUPSOTHER ETHNIC GROUP PREFER NOT TO SAYPleaase select which option you identify with.Home Address *Address Line 1CityState / Province / RegionPostal CodeThis must be the same address for all of the children listed on this booking. If any children live at another address, please remove them and complete a separate form. Email *EmailConfirm EmailContact email addressHome Phone NumberHome phone numberMobile Phone Number *Mobile phone numberPreviousNextEMERGENCY CONTACT DETAILSPlease provide the details of TWO adult contactsContact 1 Name: *Relationship to Child *Select from belowParentGuardianGrandparentAunt/UncleBrother/SisterOther familyOtherPhone Number *Contact 2 Name: *Relationship to Child *Select from belowParentGuardianGrandparentAunt/UncleBrother/SisterOther familyOtherPhone Number *PreviousNextPERMISSION AND CONSENTPERMISSION FOR PHOTOGRAPHY AND SOCIAL MEDIA *I give permission for my child to have their photo or video taken and possibly used on the UKeff social media accounts, publications and website, complying with Data Protection legislation and the UKeff Safeguarding Policy.I DO NOT give permission for my child to have their photo or video taken and possibly used on the UKeff social media accounts, publications and website, complying with Data Protection legislation and the UKeff Safeguarding Policy.PERMISSION FOR FIRST AID *I give permission for a qualified First Aider to treat my child in the event of a medical emergency. If I cannot be contacted, I am willing for my child to be given hospital treatment, including anaesthetic if necessary. I understand that every effort will be made to contact me as soon as possible.CONSENT *I give permission for my child to participate in the UKeff Easter HAF I understand that all the activities will be properly supervised by adults who have been DBS checked and will ensure my child is supervised at all times. I confirm the above details are complete and correct and I give permission for the above details to be entered on the UKeff database.DATA PROTECTION & CONFIDENTIALITYI understand that the information given on this form will be used and stored in line with UKeffβs data protection policy that follows UK General Data Protection Regulation May 2018, more details of which can be found at https://www.ukeff.org/privacy-policy/ UKeff will share this information with the Department for Education and Oldham Council. UKeff is committed to equal opportunities and seeks to assist individuals from all sectors of the community. UKeff will not tolerate the less favourable treatment of anyone on the grounds of their gender, age, race, colour, nationality, ethnic or national origin, disability, marital status, sexual orientation, responsibility for dependents, trade union or political activities, religious or other beliefs, or any other reason which cannot be shown to be justified. This policy is subject to the requirements and legislative framework as outlined in the Equality Act 2010. PERMISSION FOR ADULT MOBILE TO BE ADDED TO WHATSAPP GROUP *I give permission for my mobile phone number to be added to the UKeff WhatsApp group for the activities I have bookedI DO NOT give permission for my mobile phone number to be added to the UKeff WhatsApp group for the activities I have bookedPreviousPhoneSend and make payment
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