May 2019- Warwick Holiday Scheme booking form online payment

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Please complete a separate booking form for each child and have your credit/debit card details ready. Please note that you will not be able to save the form and return to it later or make any changes to your booking online once it is submitted.

Personal details

Full name - parent/carer

User code (if you are not a member of the University please write n/a)

Department/organisation (if you are not a member of the University please write n/a)

Alternative email

Telephone contact number

Alternative phone number

Address line 1

Address line 2

Town or city

County

Postcode

Child - first name

Child - surname

Child- DOB

Child- gender

Child religion- if other please describe

Child- first language if different from English

Child’s school year in September 2018

Please list important medical conditions and/or special educational needs and/or special dietary requirements in the space below. This includes those prohibited by religious or cultural beliefs. If n/a please note.

If your child has a medical condition/special educational need/ special dietary requirement that needs to be discussed in more detail with a member of staff please email holidayscheme@warwick.ac.uk to arrange a meeting. We will make all reasonable adjustments to accommodate your child needs.

Child- name of Doctor

Child- address of Doctor

Child- contact number for Doctor

I am also submitting a separate form(s) for sibling(s) of this child to attend the Scheme

Dates- May 2019

Please select which dates you would like to book. If you do not require a certain day please leave blank. Please note:

All day= 8am-6pm AM session=8am-1pm PM session=12pm-6pm.

Tuesday 28th May 2019

Wednesday 29th May 2019

Thursday 30th May 2019

Friday 31st May 2019

Cost and payment

Please select the correct drop-down box/boxes that are appropriate to your booking. *IF YOU DO NOT COMPLETE THIS PART OF THE FORM, YOU WILL NOT BE DIRECTED TO THE PAYMENT PAGE* UNIVERSITY DISCOUNT- Applicable to University staff and students only. Offer expires on Sunday 28th April 2019. SIBLING DISCOUNT- Applicable to external members and University members (after 28th April) who have paid full price for their first child. The sibling sessions cannot exceed the original booking but can be used for multiple siblings.

Full session

Half session

Full session- Sibling discount/ University discount

Half session- sibling discount/ University discount

Total transaction value: 0 GBP

Once you click 'Make booking' you will not be permitted to make any amendments to your booking and you will be directed to the University's online payments system. Please have your card details ready. Your booking will not be valid until the full payment is received. If you have any difficulties using this form, please email: holidayscheme@warwick.ac.uk.

Authorised collection

Information about legal contact that we should be made aware of.

Please list one person who has parental responsibility for this child. (required)

If applicable, please list the second person who has parental responsibility for this child.

Other than yourself, whom do you give permission to collect your child and to be contacted in an emergency on your behalf

First authorised person (must be 16+)

Full name (required)

Relationship to child (required)

Phone number (required)

Second authorised person (must be 16+)

Full name

Relationship to child

Contact number

Consent

Please read the Photography and Video consent form and inform us of your decision (required)

I have read and AGREE to the Photography and Video terms and conditions

I have read and DO NOT agree to the Photography and Video terms and conditions

Before making your booking, please read the Holiday Scheme Terms and Conditions. (required)

I have read and agree to the Holiday Scheme Terms and Conditions

Before booking, please read the statement below on emergency care (required)

In the event of an emergency I give permission for Warwick Holiday Scheme staff to authorise medical treatment to my child on my behalf. I understand that such action would only be taken if I was unable to be contacted.

Before booking, please read the Code of Conduct . (required)

I have read and understood the Holiday Scheme Code of Conduct

How did you hear about us? (required)

If other, please describe.

Once you click 'Make booking' you will not be permitted to make any amendments to your booking. If you have any difficulties using this form, please email: holidayscheme@warwick.ac.uk.

Privacy notice

The University of Warwick will process your personal data as captured within this registration form for the purpose(s) of registering your child for the University of Warwick’s Holiday Scheme services. Your personal data will not be shared or disclosed to any third parties external to the University of Warwick. Your personal data will not be transferred outside of the EEA, will be kept securely by the University of Warwick and will be retained until your child’s 15th birthday. You do however have the right to request that we remove your data at any point. If this is your intention please email holidayscheme@warwick.ac.uk. The University of Warwick is the Data Controller of this information and is committed to protecting the rights of individuals in line with Data Protection Legislation. Please visit the University’s Data Protection web pages https://warwick.ac.uk/services/idc/dataprotection/ for further information in relation to your rights and how the University processes your personal data. The University’s Data Protection Officer, A Bajaj, can be contacted through: infocompliance@warwick.ac.uk">infocompliance@warwick.ac.uk and any requests or complaints should be made in writing to the University’s Data Protection Officer.
The University of Warwick is the Data Controller of any information you have entered on this form and is committed to protecting the rights of individuals in line with Data Protection Legislation. The University's Data Protection webpages provide further information on your rights and how the University processes personal data. If you wish to submit a data subjects rights request, make a complaint or report a suspected personal data breach, please contact the University’s Data Protection Officer by email at infocompliance@warwick.ac.uk.