Holiday Group Registration Form

Holiday Group Registration Form
Names, dates of birth and ages of children attending the group/s:*
Child's Name

First NameLast Name
Child's Name

First NameLast Name
Year Group
Gender

MaleFemalePrefer not to say
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name*

First NameLast Name
Contact number*
E-mail*
example@example.com
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Contact number*
Does your child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Does your child currently attend therapy sessions at our clinic?*

YESNO
How did you hear about our holiday groups?

Current clientSocial mediaFriend/referralWebsiteOther
All groups will take place at our clinic in Walton on Thames except for the nature enrichment groups that will be held outdoors in our eco space a short walk from the clinic at Walton Community Allotments KT12 2DX.
Please tick the box in the top left of the image to select the group you wish to book, select quantities of number of places required. Once you submit the form you will be redirected to our secure stripe payment portal.*
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21st July: Sensory Sprouts sensory play group (ages 3-5) 10-12pmA sensory play group to explore a range of hands-on activities like messy play, water fun, tactile exploration, and themed crafts. Perfect for little ones who benefit from a gentle, engaging introduction to sensory experiences.
£100.00 Quantity



22nd July: Creative Senses sensory play group (ages 6-9) 10-12pmExplore a range of hands-on activities like messy play, water fun, tactile exploration, and themed crafts, children will have the opportunity to build motor skills, social connections, and confidence.
£100.00 Quantity



28th July: Little Explorers Nature Enrichment Group (ages 3-5) 10-12pmJoin us in our eco space for Little Explorers, a playful and nurturing nature enrichment group for children aged 3 to 5. Through hands-on activities like planting, digging, bug-hunting, and nature crafts, little ones will connect with the outdoors, engage their senses, and build confidence in a safe, supportive environment.
£100.00 Quantity



28th July: Fun with Food (ages 4-7) 10-12pmHave fun exploring and playing with food! A play-based exploration of different food types and textures using the natural, social reinforcement of playing with the food and interacting with peers.
£100.00 Quantity



29th July: Lego Club (ages 5-9) 10-12pmJoin us for an exciting LEGO holiday club where creativity meets therapy in a fun and supportive environment! This group uses LEGO-based activities to support social, communication and motor skills while encouraging teamwork and problem solving.
£100.00 Quantity



30th July: Emotional Resilience Group (ages 5-7) 10-12pmA supportive and playful group designed to help children aged 5 to 8 build emotional resilience, self-awareness, and coping skills through engaging, age-appropriate activities. Children will explore big feelings, learn tools to manage worries, and grow confidence in a nurturing environment.
£100.00 Quantity



30th July: Eco Adventurers Nature Enrichment Group (ages 10-12) 10-12pmEco Adventurers is a dynamic nature-based group for ages 10 to 12, designed to deepen connection with the environment through hands-on exploration, practical skills, and creative outdoor projects. In our eco space, children will engage in activities like gardening, wildlife observation, natural crafting, and eco challenges that spark curiosity and critical thinking.
£100.00 Quantity



4th & 5th August: Social Skills Group (ages 5-9) 10-12pmThis group will be run over 2 days. A fun and supportive group designed to help children develop the key social skills they need to connect confidently with others. Through games, role-play, group activities, and guided discussions, children will learn how to make new friends, sustain conversations, read body language, and feel more comfortable in social settings.
£200.00 Quantity



6th August: Sensory Sprouts sensory play group (ages 3-5) 10-12pmA sensory play group to explore a range of hands-on activities like messy play, water fun, tactile exploration, and themed crafts. Perfect for little ones who benefit from a gentle, engaging introduction to sensory experiences.
£100.00 Quantity



11th & 12 August: Dungeons and Dragons (ages 9-12) 10-12pmThis group will run over 2 days. Led by one of our speech therapists, this group uses the magic of role-playing games to foster confidence and communication growth. Designed for children and teens who want to improve their speech and social skills in a fun, engaging, and supportive environment.
£200.00 Quantity



12th August: Doodlebugs Fine Motor Group (ages 8-11) 10-12pmImprove fine motor skills through fun and multi-sensory exercises to improve shoulder and wrist stability, hand strength, fine motor control, in-hand manipulation, manual dexterity and handwriting skills.
£100.00 Quantity



13th August: Emotional Resilience Group (ages 8-11) 10-12pmThis group aims to help children share positive thoughts and ideas with peers; plan who to speak to and what to do when needing support; acknowledge feelings; consider what happens before, during and after an emotional breakdown or at difficult times; explore coping strategies to utilise and prevent extreme emotional reactions.
£100.00 Quantity



18th August: Wild Roots Nature Enrichment Group (ages 6-9) 10-12pmA nature-based group designed to deepen connection with the environment through hands-on exploration, practical skills, and creative outdoor projects. In our eco space, children will engage in activities like gardening, wildlife observation, natural crafting, and eco challenges that spark curiosity and critical thinking.
£100.00 Quantity



20th August: Lego Club (ages 10-12) 10-12pmJoin us for an exciting LEGO holiday club where creativity meets therapy in a fun and supportive environment! This group uses LEGO-based activities to support social, communication and motor skills while encouraging teamwork and problem solving.
£100.00 Quantity



23rd July: Doodlebugs Fine Motor Group Improve fine motor skills through fun and multi-sensory exercises to improve shoulder and wrist stability, hand strength, fine motor control, in-hand manipulation, manual dexterity and handwriting skills.
£100.00 Quantity



Total

£0.00
Informed Consent and Acknowledgement

Sensory Smart Child Therapies has taken and will continue to take every precaution to ensure the safety and wellbeing of your child/children. However, therapists or any other person (including all staff members and participants) on either our clinic or eco space premises may not be held responsible for any injury, mishap (including loss or damage to property) be it in or outside the premises caused by accident or any other reason.

I give my approval for my child’s participation in any and all activities prepared by Sensory Smart Child Therapies during the selected group/s.
Acceptance of terms of holiday groups

I, the signatory and parent/guardian of the aforementioned child/children declare that I have read, understood and accepted the conditions of the holiday groups contained in this document.
Date

MonthDayYear
Date
Signature

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Holiday Group Registration Form

All groups will take place at our clinic in Walton on Thames except for the nature enrichment groups that will be held outdoors in our eco space a short walk from the clinic at Walton Community Allotments KT12 2DX.