Consent Form – February 2020

October dates: Tuesday 18 Wednesday 19 Thursday 20

Standard day 09:30-16:30 Early Bird 08:00-16:30

Late pick-up 09:30-18:00 Full day 08:00-18:00

Participant’s name: ........................................................................................................... D.O.B: ...................................

School: ....................................................................................................................................................................................

Emergency Contacts1. Name and relationship to child: ..................................................................................................................................

Mobile number: ................................................................ Landline number: ................................................................

2. Name and relationship to child: ..................................................................................................................................

Mobile number: ................................................................ Landline number: ................................................................

Does your child have any specific medical conditions requiring medical treatment and/or medication? No Yes If Yes, give details:

..................................................................................................................................................................................................

Any other relevant information staff need to be aware of: ......................................................................................

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ConsentAs part of our commitment to children, young people and their families, we require a completed form for every child and young person by gaining parents/guardians permission before we use any images of them in our marketing literature. Your consent indicates that you are happy for us to use your child’s image or quote. Uses could include photos in leaflets, brochures and other written material, videos, CDs, presentations, East Lindsey District Council & Magna Vitae websites and associated pages on public networking sites. No names will be used in any publication.

Parental ConsentI give permission for my child to participate in this workshop

I give permission for my child to be photographed, filmed and recorded by Magna Vitae Trust for Leisure and Culture, East Lindsey District Council and its partners Signature of Parent/Guardian: ..........................................................................................................................................

Print Name: ................................................................................................. Date: ...........................................................

If you would like to receive our latest newsletters, exclusive offers, activity vouchers and much more, then please tick the box and provide your email address. I agree to Magna Vitae sending me relevant marketing information (please tick). Email: ......................................................................................................................................................................................

Your details will not be shared with third party organisations. Registered Charity No: 1160156 Magna Vitae is a Registered Charity. Charity Number 1160156. A Partner to East Lindsey District Council.

February Half TermFull Activity Days at Meridian Leisure Centre, Louth

For 5-11 year olds

Holiday Activities

Tuesday 18, Wednesday 19 & Thursday 20 February 2020

Please hand completed form to the Reception Team at Meridian Leisure Centre

How do I book?1. Visit Meridian Leisure Centre and speak to a member of the

reception team.

2. Telephone Meridian Leisure Centre on 01507 607650. A consent form must be completed prior to attending, please see back page.

What does my child need?• Trainers and comfortable clothing (including a waterproof jacket)• Lunch• Snacks• Plenty to drink• Only over 8s can swim in the afternoon. If you wish for your child

to swim please bring swimming clothing and a towel.

Children will be supervised at all times by qualified and DBS checked staff.

Full Activity Days Tuesday 18, Wednesday 19 and Thursday 20 FebruaryStandard Activity Day 09.30-16.30 £20.00

Standard Day with Early Drop Off 08.00-16.30 £23.00

Standard Day with Late Pick Up 09.30-18.00 £23.00

Full Day 08.00-18.00 £25.00

Activity Package

Additional water based activities throughout February half term

Date Activity Time Stage PriceMonday 17th -Friday 21st February

Crash Course Swimming Lessons (30 mins per day) (5 consecutive days)

8.30am-9am 1& 2 and 3&4

£26.35

Monday 17th February

Deep end water confidence workshop (30 mins) (perfect for those moving up to stage 5)

9am-9:30am 4+ £5.00

Float Session (floats in the main pool for the hour)

1pm-2pm All Ages normal swim session

Tuesday 18th February

Diving workshop (30 mins) 9am-9:30am 5+ £5.00

Breaststroke legs workshop (30 mins) 9am-9:30am 4+ £5.00

Wednesday 19th February

Deep end water confidence workshop (30 mins) (perfect for those moving up to stage 5)

9am-9:30am 4+ £5.00

Float Session (floats in the main pool for the hour)

1pm-2pm All Ages normal swim session

Thursday 20th February

Badge Sessions (400m & 600m) 9am-10am - £3.75 or FREE for

WaterWiseBadge Sessions (800m) 10am-11am -

Badge Sessions (1000m & 1500m) 9am-11am -

Float Session (floats in the main pool for the hour)

1:30pm-2:30pm

All Ages normal swim session

Friday 21st February Badge Sessions (25m & 50m) 9am-9:30am -

£3.75 or FREE for

WaterWise

Saturday 22nd February

Float Session (floats in the main pool for the hour)

2pm-3pm

All Ages

normal swim

session

Sunday 23rd February

Float Session (floats in the main pool for the hour)

2pm-3pm

All Ages

normal swim

session

These sessions have limited numbers so booking is essential. To book, contact reception directly on 01507 607650.

Don’t forget to pick up our new pool programme!