Roadmap SEND Support Club Booking Form

The form on this page is for Young People and Families to book places for the Fit for All Club sessions at Pickwick Cricket & Padel Club on 25 May 10am-1pm in West Bromwich and Monster Mayhem Soft Play at Star City on 29 May 9-11am which are being hosted by Roadmap SEND Support Group.

Fit for All Club is for SEND Young People aged 5-18 years and their families.

Fit for All Club events are either free or low-cost. For each of these session it costs:

£2.50 for a Young Person who is a Club Member and an Adult to attend

£4 for a Young Person who is a Club Member and an Adult and One Sibling

£5 for a Young Person who is a Club Member and an Adult and Two Siblings.

To book places, you need to pay online using a credit or debit card (we’re working on Paypal). You do have to book in advance – because we need to know numbers and get things ready for you. You will not be able to pay on the door.

If you need to get in touch with Roadmap – who are hosting the session – text Masuma on 07783936517

Please enable JavaScript in your browser to complete this form.

Young Person's Name *

First

Last

Young Person's Date of Birth *

Enter Membership Number or '0000000' to Join Today *

Enter your membership number above. If you need to register for membership, then enter 0000000 and complete the pop-up registration details. You can then book and pay for places below.

Young Person's Gender *— Select Choice —FemaleMaleOtherPrefer Not to Say

SEND Support and Making You Welcome *

Please tell us a bit about the SEND Support you get at school or relevant diagnoses. Are there things we need to do to make you feel welcome at Club events?

Tick those that apply: *

• Autism (ASC)
• Moderate Learning Difficulty
• Severe Learning Difficulty
• Profound and Multiple Learning Difficulty
• Social, Emotional and Mental Health Needs
• Speech, Language and Communication Needs
• Hearing Disability
• Visual Disability
• Multi-sensory Disability
• Physical Disability
• Other

Ethnicity *— Select Choice —White BritishPakistani or Pakistani BritishBlack Caribbean or Black BritishBlack African or Black BritishIndian or Indian BritishBangladeshi or Bangladeshi BritishArab or Arab BritishOther

We collect data on ethnicity so that we can show funders the range of young people that come.

Other Ethnicity

You can use the box above to describe your ethnicity in your own words.

Home Postcode *

Responsible Adult's Name *

Name of School (or Home Educated; or Not in School) *

For a directory of schools see Birmingham City Council’s Directory of Schools

Are you entitled to Free School Meals *— Select Choice —Not sureYesNoNot in school education

For information see Birmingham City Council Free School Meals

Mobile Number *

Email *

Book Places at Pickwick Cricket & Padel 25 May 10-1pmNone at this event – £0.00Member and Adult – £2.50Member, Adult and Sibling – £4.00Member, Adult and 2 Siblings – £5.00

A Young Person who is a Member and the Adult coming with then can also bring up to two Siblings to each session. Select the option you want – and if you are bringing Siblings, then please enter their details below:

Book Places at Monster Mayhem 29 May 9-11am None at this event – £0.00Member and Adult – £2.50Member, Adult and Sibling – £4.00Member, Adult and 2 Siblings – £5.00

A Young Person who is a Member and the Adult coming with then can also bring up to two Siblings to each session. Select the option you want – and if you are bringing Siblings, then please enter their details below:

Sibling 1 Name *

Sibling 1's Date of Birth *

Sibling 1 Gender *— Select Choice —femalemaleotherprefer not to say

Sibling 1 Home Postcode *

Sibling 1 Name of School (or Home Educated; or Not in School) *

For a directory of schools see Birmingham City Council’s Directory of School

Is Sibling 1 entitled to Free School Meals? *— Select Choice —Not SureYesNoNot in School

Does Sibling 1 get SEND support at school? *— Select Choice —NoYes, please register them as wellYes, but don’t register them

If your child does get SEND support at school, then you can register them for membership of the Fit for All Club as well.

Sibling 2 Name *

Sibling 2's Date of Birth *

Sibling 2 Gender *— Select Choice —femalemaleotherprefer not to say

Sibling 2 Home Postcode *

Sibling 2 Name of School (or Home Educated; or Not in School) *

Is Sibling 2 entitiled to Free School Meals *— Select Choice —Not SureYesNoNot in School

May School Name

Does Sibling 2 get SEND support at school *— Select Choice —NoYes, please register them as wellYes, but don’t register them

If your child does get SEND support at school, then you can register them for membership of the Fit for All Club as well.

Consent *

• I am the person with parental responsbility named above and I give my consent for my child/children to join the Fit for All Club; for their personal data to be used and stored by Childrens Quarter, the Fit for All Foundation and DENS of Equality and organisations working with them to run the Fit for All Club and provide opportunities to young people who are members of the club; and for Fit for All Club to contact me about this and future opportunities. I understand that I can cancel this membership and withdraw this consent at any time; that I will be given a copy of the data held by the Fit for All Club that relates to my child/children; and that this data will be stored securely and processed and used responsibly.

Total Payment Due

£0.00

Stripe Credit Card *

Submit

If you have trouble with the form, you can WhatsApp the club on 07874437535. This number is only for technical help with the form, not for details of the session.