Childrens Activities Application Form

Childs first name (required)

Childs last name (required)

Please leave this field empty.

Childs gender (required)
MaleFemalePrefer not to say

Childs Date of Birth (required)

Address and postcode(required)

Name of school(required)

Camp Venue: LSBU Hub 116-119 London Road, SE1 6LN

Camp Attendance Date/s:(required)

Please state which ethnic group you most identify your child:
This information will be used for equality and diversity monitoring purposes only and is optional.

White: EnglishWelshScottishIrishNorthern IrishBritishGysie or Irish TravelerAny other White Background
Black / African / Caribbean / Black British: AfricanCaribbeanAny other Black / African / Caribbean background
Mixed / Multiple ethnic groups: White & Black CaribbeanWhite & AsianWhite & Black AfricanAny other Mixed / Multiple ethnic background
Asian: IndianPakistaniBangladeshiChineseAny other Asian background
Other Ethnic Group: ArabAny other Ethnic groupPerfer not to Say
Prefer not to say: Perfer not to Say

Does your child have a disability, medical condition, allergies, dietary needs, ADHD, history of difficult behaviour, etc? This information will allow us to discuss the child’s needs with the parents/carers ahead of the activities and make reasonable adjustment to our programme where possible.YesNo
If Yes, please include further details to assist us here:

Does your child have Specific medication requirmentsYesNo
If Yes, please include further details to assist us here:

Any other information you think we should know about?

First name (required)

Last name (required)

Telephone/Mobile no (required)

Password for Pick up (required)

Do you work/study at LSBU? (required)
YesNo

Email address

First name (required)

Last name (required)

Telephone/Mobile no (required)

Email address

Please confirm here if you are paying with childcare vouchers, tax free childcare or the student childcare grant payment service.

I give permissions for photographs and videos to be taken during sessions that will be used for marketing and promotional purposes on the LSBU Active website, marketing and social media.
YesNo
I would like to receive emails regarding services, updates and offers for children and parents.
YesNo
How did you hear about us?
Student/ Staff NewsletterOnline Search EngineSchool Referral (Please state which School)Social Media (Please state which platform eg Facebook)Social Media PromotionSouthwark NewsletterReferral from a friendFlyers/ Posters

I confirm I have read and understood the Sports Camp terms and conditions here