VICTORIA ADVENTURE DAYS

Booking Application Form

Initial Information
Parent/Carer
Name
Address
Email Address
Phone Number
Mobile Number

Child
Name
D.O.B.

Young Persons Information

As a provider we ask all parents/carers to complete an information pack to assist us in providing the best possible
care to your child and allow them to gain the most benefit from their Adventure Day.
These documents need to be renewed whenever you childs needs change. It is your responsibility to ensure they
are kept up to date. We will also ask you to renew these documents at a minimum of every two years.
Please indicate (tick) the status of your information pack:
Complete and Up to
Date

Needs Updating

Yet to Complete

Care Passport
Medical Profile
Swimming Assessment
(non-VEC students)
If you have indicated forms need updating/completing, you will receive the relevant forms from us.
Your childs place cannot be confirmed until all parts of the information pack are complete.

Activity Options
st

nd

Please select a 1 and 2 choice option for each section (listed on holiday brochure). We cannot guarantee they
will be offered their preferred option.

Date

AM 1st Choice

AM 2nd Choice

PM 1st Choice

PM 2nd Choice

Funding Options
There is a set cost for each childs Adventure Days, with residents of Bournemouth and Poole benefitting from a
limited number of heavily subsidised places.
Please indicate the appropriate box for your child indicating the appropriate level of support your child requires
to access Adventure Days in a safe and enjoyable manner, in consideration of any physical, behavioural, or
medical difficulties your child experiences.
From Easter 2016 we are restoring Adventure Days to 4pm. The extra hour (optional) will cost an additional 10
for 1:2 support, or 15 for 1:1 support.
Childs Local Authority (please indicate)

Requires 1:1 Support

Requires 1:2 Support

EXTRA HOUR

Bournemouth: 50
Poole: 50
Dorset: 125
Other: 125

Bournemouth: 15
Poole: 15
Dorset: 90
Other: 90

Please tick this box if you

would like to book your child
in for an extra hour (until
4pm).

Child requires a dedicated

support worker.

Child can share support with

another young person.

10 Extra Per Day for 1:2

15 Extra Per Day for 1:1

COST PER DAY _________ x NUMBER OF DAYS BOOKED _________ = TOTAL COST _________
I enclose a cheque for ....................... payable to Victoria Education Centre. Please write your childs name on the
back of the cheque.

What Next?
Please fully complete this form and send it to us, along with your payment:
By Post
By Student
By Email

Adventure Days, Victoria Education Centre, 12 Lindsay Road, Branksome,

Poole, BH13 6AS
If your child is a student at VEC, feel free to ask class staff to pass on to
Julie Davies.
jdavies@victoria.poole.sch.uk. Payment MUST also be sent in.

The closing date for applications is 16th May 2016.

We will send you a booking confirmation, via the email address you provided above, confirming which
dates and activities we can offer you by 20th May 2016. Your place is not guaranteed until this time.
If you have any queries, please contact Julie Davies via email on jdavies@victoria.poole.sch.uk or via
phone on 01202 763697.