2022 Reach Activity Week Registration Form

Campaign ID

Reach Child Details

First Name

Last Name

Address

Postcode

Date of birth

Child's age on 24th July 2022 (must be between 10 & 17 on these dates)

I/we agree to our child being photographed for use in Reach publicity?

YesNo

Medical Details

Doctor's Name

Doctor's Surgery Address

Doctor's Phone Number

NHS Number

Emergency Contact Details One

First Name

Last Name

Mobile Number

Landline Number

Emergency Contact Details Two

First Name

Last Name

Mobile Number

Landline Number

Coach Travel

I/we would like our child to be included in coach travel arrangements. These will be confirmed closer to the time

YesNo

Reach Activity Week T-shirt

This year RAW t-shirts are available, the 2022 edition must be pre-ordered and paid for with the deposit - they will be ready for collection at The Pioneer Centre. You can also order a Reach water bottle if you wish.

T-shirt Size

Contribution

Please indicate the amount you wish to contribute, minimum is £395, however the actual cost is closer to £650+ & we are most grateful to those families who are able to contribute nearer to the full amount. If your child would like to go to RAW but the £395 contribution is too much for you this year, please get in touch with head office at reach@reach.org.uk & we will discuss what we can do to help subsidise the place further.

This payment will be taken at a later date

Booking Deposit & T-shirt

Your child's place will be confirmed on receipt of a minimum deposit of £50 and payment for the t-shirt, if ordered, must be made now.

Payments can be made 3 ways, please tick how you will proceed;

1. Click donate now on the website and pay by credit card, using reference RAW 22/surname.
https://www.paypal.com/donate/?hosted_button_id=PD6ZV65Z746N2

(This is our preferred method of payment as it streamlines into our systems best).

2. BACS payment to Reach Charity Ltd please use the reference RAW 22/surname, to sort code 40-52-40, account no. 00028547

3. Give us a call in the office and we can take payment by credit or debit card.

The balance is due by 15th June2022, an invoice will be sent directly to you by email before this date but should you wish to pay earlier please contact head office via email at reach@reach.org.uk or phone 0845 130 6225 or 020 3478 0100 from a mobile.

Please indicate how you wish to pay (details above)

Behaviour Policy

You can view our Behaviour Policy here

I/we (including our child) have read the behaviour policy & by signing this form agree to it. *

Yes

Submit Booking

We are at the end of the phone and always happy to answer questions.

If you need to cancel your child's place please note that it is our policy to offer a full refund (minus the non-refundable deposit), up to 30 days before departure. If you are cancelling within the final 30 days, we are happy to refund only if we are able to fill the place with another child, if not we cannot offer a refund even in part.

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