Amber Valley School Sport Partnership CIO

Ripley Leisure Centre – Holiday Camp

Address: Derby Rd, Ripley DE5 3HR

8:30am – Drop off   3:00pm – Collection

Camp Dates: Mon 7th – Fri 11th Apr

A reminder that this booking page is solely for those children (aged 5-11 years old) in receipt of Pupil Premium funding.


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Number of Children*:
If you require a booking for more than 2 Children, please complete a second booking form.

Child 1 Full Name*:

Child 1 D.O.B* (dd/mm/yy) Children must be aged 5-11 years old:
Invalid date (dd/mm/yy).

Child 1 Emergency Contact Number*:

School*:

School Year*:

Medical Info*:

Dietary Requirements/Allergies*:

Special Educational Needs/Disability Information*:

Does your child recieve regular 1to1 support in school?*:
 Yes No


Please only complete Child 2 details if you have selected 2 Children from the option above.

Child 2 Full Name:

Child 2 D.O.B (dd/mm/yy) Children must be aged 5-11 years old:
Invalid date (dd/mm/yy).

Child 2 Emergency Contact Number:

School:

School Year:

Medical Info:

Dietary Requirements/Allergies:

Special Educational Needs/Disability Information:

Does your child recieve regular 1to1 support in school?:
 Yes No



Parent Name*:

Email*:

Phone* (please ensure that you have provided us with two different contact numbers):

Postcode*:


Any Additional Info / It’s About Me code:


Do you agree to photos to be taken of your child for marketing and promotional materials?  Yes No

Do you agree to your child/children walking to and using the facilities at one of our Partner Sites? (see risk asssessment for more info)  Yes No

Do you agree to information being stored and processed for communication purposes in accordance with GDPR?  Yes No

Please tick to state you have read and agree to our Terms and Conditions.  Agree

Please tick to state that the children included in this booking form are in reciept of Pupil Premium funding.  Agree

If you have any queries please direct them to holidaycamps@avssp.co.uk 

You can find our Terms and Conditions and Risk Assessments for our holiday camp provision by clicking the links below.

Terms and Conditions

AVSSP Holiday Camp Risk Assessment