Queen’s Park Sports Centre Photography I give permission for photographs of the named young person undertaking the named activity, to be used for publicity and promotion of childrens’ and young peoples activities by Chesterfield Borough Council. Yes No I consent to the named young person taking part in the named activity (please note in order to give consent you must be the named young persons parent, guardian, carer or a relative over the age of 18). Signed: Date: Prices and times Full day: 9am-4pm. Drop off 8-9am / pick up from 4-5pm. £10.80 Active Chesterfield members (£12.00 non members) Half day: 9am-12noon / 1pm-4pm. Drop off 8-9am / pick up 12noon/1pm Drop off 12noon-1pm / pick up 4-5pm £5.40 Active Chesterfield members (£6 non members) Multi sports activities will run alongside all activities. All water activities come with a dry side option. A consent form must be filled in for each child upon booking, without this they will not be able to participate. All activities must be paid for at the time of booking. All activities are subject to our terms & conditions and subject to change. For further information Queen’s Park Sports Centre Boythorpe Road, Chestefield S40 2ND Tel: 01246 345555 www.chesterfield.gov.uk/queenspark Active Easter Easter holiday programme Monday 30 March – Thursday 10 April Activities for children aged 6-14 years. Full day and half-day sessions available Young persons consent form Name of Young Person: Timetable Day Address: Week 1 Monday 30 March – Thursday 2 April Monday (AM) Gymnastics Monday (PM) Team Games Tuesday (AM) Arts and Crafts: make your own armour Tuesday (PM) Fencing Week 2 Tuesday 7 April – Thursday 10 April Date of birth: Easter Monday – no activities Emergency Telephone number: Booking information Actvity Course: Make your own egg (papier-mâché) competition – winner will get an easter egg Decorate your egg in afternoon Multi sports played throughout the day Wednesday (AM) Rounders & Kwik Cricket Dodgeball and Benchball Wednesday (PM Trampolining and open tumbling with Crystal Cheer & Dance Netball / Basketball Thursday (AM) Water Polo Dry side option available Water Polo Dry side option available Thursday (PM) Racquet sports Trampolining and open tumbling with Crystal Cheer & Dance Friday (AM) Good Friday – no activities Gymnastics Friday (PM) Who do we contact in an emergency?: Water Rave (age 8+ must be able to swim 50 meters) Dry side option available Venue: Date of activity start date: Finish date: Medical conditions/Special Needs/Allergies Please write in the box details of any relevant medical condition. Please Note: our staff are unable to administer any medicines to children taking part in the sessions. If you would like to be added to our mailing list to recieve information on future activities at the centre. Please provide your email below: Email: _________________________________________________ . please turn over