Trefoil Ashwood Farm
Activities & Workshops 2013
Registration Form
email:p.vickerman@btinternet.com
01342
316129
caz.catherinegreenwood@gmail.com
SummerActivities
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Child’s Full Name
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Date of Birth
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Nationality
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Languages spoken
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Fee enclosed
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Home Tel No
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Home Address
Post Code
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E mail address
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Fathers Name
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Mothers Name
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Occupation
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Occupation
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Tel No
Mobile
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Tel No
Mobile
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Name and Address of
family doctor
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Record of
Vaccinations and Immunisations
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Child’s Medical
History
If your child has
SEN please give details
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Food or
other allergies
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Please enclose any
further details you feel we need to be aware of on a separate sheet.
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Activities: Summer
2013 (please circle the relevant activity
dates)
Monday 29 th
July…………………………10-3pm
Tuesday 30th
July…………………………10-3pm
Wednesday 31st July………………………...10-3pm
Thursday 1st
August………………………..10-3pm
£25/day
(2nd child 10% discount)
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Additional
information (please include any other carers names, telephone no’s and any
other details)
If you are happy for
us to take photos of your child during the activity week please sign below.
We will use them
only to publicise future activity schools at Ashwood Farm.
…………………………..(Please
sign)
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Please read the
statement and sign in the spaces provided
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CONDITIONS OF ADMISSION
1.
Fees are paid
in advance and payable to Trefoil Montessori and sent to:
2.
Trefoil Montessori Farm School- Ashwood Farm West Hoathly
Road East Grinstead West Sussex RH19 4ND
tel: 01342 316129
Please pay in
advance to ensure a place for your child.
3. We will need a full weeks notice, if
you need to cancel your
booking.
We hereby make application for entry of
our child into Trefoil Montessori Farm School Holiday Activities in accordance
with the conditions shown above, and agree to conform to all the rules of the
school. N.B. It is important that both parents sign
if possible. Please see Health & Safety Policy for further details.
Signed:.............................................................................................
Date:.......................................……………………
Signed:.............................................................................................
Date:.......................................……………………
We give
permission for our child to be transported by car or ambulance to the local
hospital in the event of an emergency if we cannot be contacted in advance.
Signed:...........................................................................................
Date:.........................................
Signed:...........................................................................................
Date:.........................................
If in the event that your child may need
simple first aid, we will offer your child rescue remedy, Tea tree oil and
colloidal silver, where appropriate.
If you are happy for us to use these
remedies, please sign below.
Signed ……………………………………………………………Date:………………………
Are you camping on site?
Which nights and how many adults and
children?…………………………………………………………
Many Thanks, Wendy Vickerman
