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Holiday Club - Application»

Holiday Club - Application

Monday 16th to Friday 20th February 2026

Contact details for your child

Child's Family Name (Surname) :* Child's First Name :* Date of Birth :* Parent / Carer Name :* Contact Details (telephone) :* Emergency Contact :* Parent / Carer email address :* My child will be collected by:*

My child can walk home alone :*YesNo

Your Child

Child's Full Name* School & Class*

Does your child have any medical needs?*YesNo

If yes, please provide details. Please note should your child require medication to be administered during their time at the Holiday Club a consent form will need to be completed.

Does your child have any additional needs?*YesNo

If yes, please give details:

Sessions

Daily sessions start at 08:45am and finish at 16:45pm and cost £25:00. We also provide an additional hour in the morning (07.45 to 08:45) and an additional hour in the evening (16.45 to 17.45), the cost is £5 for each additional hour attended. TRIPS - Please note we have a limited amount of spaces per trip, therefore early booking is advised to avoid any disappointment. Please note children have to be 5 years old and over to attend any trip.

Please indicate below which days your child will be attending*Monday 16thTuesday 17thWednesday 18thThursday 19thFriday 20th

Monday 16th08:45am-4:45pm7:45am-8:45am4:45pm-5:45pmLunch required (£3:00)Packed lunch provided

Tuesday `17th08:45am-4:45pm7:45am-8:45am4:45pm-5:45pmLunch required (£3:00)Packed lunch provided

Wednesday 18th08:45am-4:45pm7:45am-8:45am4:45pm-5:45pmLunch required (£3:00)Packed lunch providedBowling - £15:00

Thursday 19th8:45am - 4:45pm7:45am -8:45am4:45pm - 5:45pmLunch required (£3:00)Lunch providedAdventure play -£15:00

Friday 20th8:45am - 4:45pm7:45am - 8:45am4:45pm - 5:45pmLunch required (£3:00)Lunch provided

Total cost*

I have read and accept the Terms & Conditions for Mission Grove Primary School Holiday Club*YesNo

Payment method:*Parent Pay (only for children who attend Mission Grove)Bacs TransferChildcare Vouchers (please provide a reference number)

Our school dinners cost £3:00 per day. If your child brings a packed lunch no items can contain NUTS or GELATINE. Please state if your child has any special dietary requirements due to allergic reactions, cultural or religious beliefs.

I give consent for my child to be photographed or filmed and these images may be used on the school website and / or twitter account or Local Authority promotions.*YesNo

On receipt of the online Registration Form you will receive confirmation if there is availability and pricing confirmation. Please note that once a space is confirmed by the Holiday Club you will be entering into an agreement with Mission Grove Primary School whereby you agree to pay for the sessions booked. Unless notification of the space no longer being required is provided during the booking period, the Parent / Carer will still be liable to pay for the sessions booked. Cancellation after the booking period has expired will incur charges totalling 50% of the price confirmed. Payments can be made via Parent Pay (if your child attends Mission Grove), childcare vouchers, or bacs payment. Payment needs to be made in advance, we can no longer take payment on the first day your child attends. Payment needs to be made when booking confirmation is received. Mission Grove Primary School reserves the right to exclude children if fees remain unpaid from any child’s previous attendance and parents are advised to contact the school in case of any difficulties with payments. No refunds will be given for non attendance due to sickness or any other absence or for sessions only part attended. Consideration to a refund will be given in exceptional circumstances and at the authorisation of the Headteacher. If any fees are outstanding from previous attendance of a Holiday Club, or any other payment item provided by Mission Grove Primary School, the school will reserve the right to refuse your child a place for future Holiday Clubs until all outstanding debt is cleared. Mission Grove Primary School requires written notice if you no longer require a place for your child or wish to make any changes to the days attended. All changes will be subject to agreement by Mission Grove Primary School and will be subject to availability and will attract a £10 administration charge per change. Print Full Name & Date*

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Holiday Club - Application

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