Home-Ed Booking Form

Booking Form

Please fill in all the details and submit your booking form. Be sure to get in touch if you have any questions.

Payments made to
Buck Green Ltd
Sort Code: 60-83-71
Account: 73706859

lorna@kithhomestead.com
07843813736

Kith Homestead
Horn Bank Farm
North Rigton
LS17 0DS

Parent Name

First Name

Last Name

Parent Phone Number

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Child's Name

Child's Date of Birth

YYYY

Any allergies, special requirements or additional information we should know about (food, medication, sunscreen allergies etc).

Second Child's Name

Second Child's Date of Birth

YYYY

Any allergies, special requirements or additional information we should know about your second child.

Third Child's Name

Third Child's Date of Birth

YYYY

Any allergies, special requirements or additional information we should know about your third child.

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone Number

Disclaimer

Please read our disclaimer By selecting "yes" from the drop down menu you agree to our requirements. Health & Safety To ensure the safety of all children who attend we require the name of the person/s that will be collecting your child from the club or any persons who have parental responsibility. This information will be required on the booking form. Please note that we will not hand over any child without prior permission and may contact you to clarify this person’s identity. A password will be required for collection of the child. Should your child become unwell or incur an injury which merits leaving the session early, we will contact the parent then the emergency contact on this form. By signing the disclaimer form you confirm that you understand there are inherent risks associated with outdoor activity(s) All activities provided by Kith Homestead can be physical and may have inherent hazards associated with them that can result in death and/or injury. While every precaution has been made to ensure the safety and wellbeing of every person on site, accidents can still happen. Risk Assessments and our policies and procedures including our safeguarding policy, are available at all times at the following link https://www.kithhomestead.com/policies-and-procedures Personal Property Whilst every reasonable care will be taken, Kith Homestead cannot be held responsible for any loss or damage to a child’s property. We request that children’s own toys and precious items are not brought to Kith. Suitable Clothing Policy You are responsible for providing adequate clothing for your children fit for the purpose of being outdoors in all weather. This means weather appropriate clothing and sturdy footwear. (Wellies or walking boots are ideal) Even on sunny days long trousers and long sleeves are preferable. This is to avoid scratches, stings and bites. Please bring more rather than less.. Please don’t bring anything of high value or sentimental importance. You will be sent a kit list prior to attending. Toileting We have a composting toilet on site we will teach the children how to use. There are full picture instructions how to use it inside. The toilet will be inspected and cleaned regularly to ensure high safety standards. There are appropriate hand washing facilities to maintain hygiene. Please talk to your children about this and feel free to point it out to them before leaving. Let us know if your child is likely to need more support in using it. We understand that new things can feel funny at first. Behaviour Management Everybody is encouraged to treat each other with care and respect and behave in a manner that is acceptable. Continuous unacceptable behaviour will be challenged by staff and recorded in the incident book. Parents will be asked to sign this entry. If the behaviour does not improve then Kith Homestead has the right to refuse any subsequent bookings. When children and /or their parent display behaviour likely to cause offence Kith Homestead reserves the right to refuse or withdraw them immediately. Cancellation of Place If your allocated place is no longer required no refunds can be made. Fees are non-returnable or transferable if your child does not attend for any reason. If Kith Homestead needs to cancel for any reason full refunds will be offered. Complaints Procedure If you or your child is unhappy with the service or the staff, please see our Policies and Procedures document at the link above. Your concerns will be treated with respect and confidentiality. Data Kith Homestead requires the information you share with us to run our activities and to satisfy our legal responsibilities. We’ll keep it safe for as long as your child/ren attend the holiday club. We promise we’ll only share your information if: you ask us to or the law requires us. We’ll never sell your data or share it for any other reason. Weather Apart from high winds, extreme heat and sub zero temperatures we will be out. In case of hazardous weather conditions you will be notified of alternate options. Allergies Please inform us of any known allergies or dietary requirements your children have for campfire cooking. Please check the box below to acknowledge you have read and understood the above elements.

Sunscreen

Please ensure your child is prepared for sun exposure; sun hat and sunscreen are compulsory in their kit bag. If your child is not able to apply sunscreen themselves, confirm below whether you consent to Lorna applying it for them.

Photography

Images taken during the class may be used for promotion; including press releases; publicity materials including leaflets and presentations. Images will not be accompanied by names or other details that could identify individual children or young people. I am happy for photographs/videos to be taken of my child during activities and used in local press releases, communications, publications or Kith Homestead websites and social media pages.

In case of someone else picking up your child, what secret word/phrase would you like to use?

Declaration

I have read, understand and agree to the terms and conditions and disclaimer. I have disclosed any medical information which will be needed. I give my consent for the administration of basic first aid treatment by qualified first aid provider. I give my consent for an ambulance to be called on my behalf for my child providing immediate notification is given to me. On arrival for each session all children must be accompanied by a parent/carer until they have been signed in. Kith Homestead takes no responsibility for lost or stolen valuables. Continuous, disruptive and unacceptable behaviour by any child will result in their removal from the activities without refund. Children should be appropriately clothed for participation in all activities. Please type your name in the box below to confirm.

Home-Ed Booking Form

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