First Name *

Last Name *

Address *

Street Address

City

State

Postal Code

Phone *

Email *

Childs Full Name *

Childs Date of Birth *

2nd Child's Full Name

2nd Child's Date of Birth

3rd Child's Full Name

3rd Child's Date of Birth

Has your child (ren) got any medical/additional needs? *

8:00am - 6:00pm £35 per child per day

9am - 4:00pm £30 per child per day

8:00am-12:30pm £20 per child per day

1:30pm-6pm £20 per child per day

Time Slot you require *

8:00am - 6:00pm

9:00am - 4:00pm

8:00am - 12:30pm

1:30pm - 6:00pm

(Week 4) Day/s Required *

Monday 10th August

Tuesday 11th August

Wednesday 12th August

Thursday 13th August

Friday 14th August

I will provide my child with suitable footwear, clothing and hydration throughout the course of the day. *

Yes

I give permission for KSA to administer first aid to my child? *

Yes

I give consent for my child's photo/video to be taken and used for marketing use. *

Yes

Are you paying through Childcare Vouchers or Tax Free? *

Childcare Vouchers

Tax Free

Which Child care voucher provider will you be using?

Your booking via childcare vouchers WILL NOT be confirmed until you send The KSA Group a screenshot of your voucher company authorisation to [email protected] You will liable for such outstanding childcare costs should this not happen.

Your booking via Government Tax Free WILL NOT be confirmed until you email The KSA Group your payment reference at [email protected] You will liable for such outstanding childcare costs should this not happen.

I understand failure to turn up without 48hr notice will still require in FULL PAYMENT being made. *

Yes I understand