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What‘s on
Winter Holiday Activities & Food Programme (HAF)
December 2024 Registration Form
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Forename
Surname
Also known As
Date of Birth
Their Age
Gender
Male
Female
Transsexual Female
Transsexual Male
Non-binary
Prefer not to say
Unknown
Prefer to self-describe
If you prefer to self describe, please specify:
How would you describe your ethnic status
Asian/Asian British - Bangladeshi
Asian/Asian British - Chinese
Asian/Asian British - Indian
Asian/Asian British - Pakistani
Asian/Asian British - Other
Black/Black British - African
Black/Black British - Caribbean
Black/Black British - Other
Mixed/multiple ethnic groups - White and Asian
Mixed/multiple ethnic groups - White and Black African
Mixed/multiple ethnic groups - White and Black Caribbean
Mixed/multiple ethnic groups - Other
White - Welsh/English/Scottish/Northern Irish/British
White - Irish
White - Eastern European
White - Gypsy, Roma or Irish Traveller
White - Other
Other ethnic group - Arab
Other ethnic group - Other
Prefer not to say
Unknown
Disability/ Additional needs
Yes
No
Prefer not to say
Unknown
If yes, please specify
Attention-deficit/hyperactivity disorder
Autistic Spectrum Disorder or Asperger Syndrome
Blind or partially sighted
Complex disabilities
Deaf or hearing impairment
Emotional/behavioural difficulties
Mental health difficulties
Multiple disabilities
Temporary disability after illness or accident
Unseen disability (e.g. diabetes, epilepsy, heart condition)
Wheelchair user or mobility difficulties
If yes, please give details below
Please note if you fail to disclose any additional needs your child may be denied a place. It is important that your child’s needs are clearly explained, failure to disclose may result in your child's space being withdrawn. Bromley’s HAF Team works closely with our services and partners that offer provision for children and young people with more complex needs. If the needs of your child exceed what we can safely offer in our provision, we will refer you to Bromley’s HAF Team who will signpost you to other holiday activities and services available that could meet the needs of your child.
Is your young person a Bromley Resident?
Yes, my young person lives in Bromley.
Yes, my young person attends school in Bromley.
No, my young person does not live or attend school in Bromley.
Address Line 1
Address Line 2
Town/city
Postcode
Email
Name and Postcode of school attended
Emergency contact: name
Emergency contact: Mobile No.
Emergency contact: relationship
Is your young person a clarion resident?
Yes
No
Don't know
Does your young person get free school meals?
Yes
No
Do you have any Dietary requirements, Allergies or Medical Conditions?
Yes
No
If yes, please give details:
By signing up to the programme you are agreeing for your child/young person’s data to be shared with Bromley Council for programme monitoring purposes
I understand that during courses/activities run by the CPCT or within Anerley Town Hall photographs and videos may be taken of me/my child for promotional purposes. I give permission for these to be used in social media and hard copy promotional materials. (Tick to indicate yes)
Do you wish to be on our youth mailing list? (Tick to indicate yes)
I understand that I/ my child must abide by the rules appropriate to the service/activity they are attending. Failure to abide by them may result in temporary or permanent exclusion. (Tick to indicate yes)
123Anerley Youth Club Holiday Club Dates: Which specific day(s) do you wish for your young person to attend?
Monday 23rd December 2024
Monday 30th December 2024
Thursday 2nd January 2025
Choose preferred dates
Submit