Coping with CHAOS Weymouth - Booking form

Christmas Holidays 2023

Please complete the form in full to request sessions for the Christmas Holiday. All sessions are held at Weymouth Outdoor Education Centre, Knightsdale Road, Weymouth, DT4 0HS, however times may vary so please check the timetable before booking sessions.

You can request as many sessions as you wish. After the closing date we will allocate spaces and you will then receive an email confirming which sessions your family have been allocated, followed by an invoice from our accounts department. Invoices are required to be paid before the session.

You can cancel sessions up until Sunday 3rd December without a charge, however after this date we will not be able to issue refunds.

Please note: this form must be submitted by the end of Sunday 19th November

Child's name

First Name

Last Name

Child's Date of Birth

Home postcode

Local Authority

BCP

Dorset

Email address for booking outcome

Parent/carer name

First Name

Last Name

Session selection

From the drop downs below please choose the morning, afternoon or either session for each day you are interested in. For each session which you request, please also complete the relevant boxes underneath with the names of ALL children attending that session.

Tues 19th Dec

Name of child/children with additional needs attending:

Name of all siblings attending:

Thurs 21st Dec

Name of child/children with additional needs attending:

Name of all siblings attending:

Thurs 28th Dec

Name of child/children with additional needs attending:

Name of all siblings attending:

Feedback Form

Due to the ever-growing requests for feedback from our funders, it is now required for us to gather the views/opinions of the young people who we support and their families. Please complete the feedback questions below.

What are the benefits or outcomes for the young person who attends Chaos sessions?

What are the benefits for the parents and/or siblings?

Any other feedback, comments or ideas for the future?

Personal details collected from these forms, will only be used to provide you with the services described on these forms. We promise to make all reasonable efforts to keep your details secure, and will only share them with third parties working on our behalf, as required. Except as required by law, we will never share your details with other organisations to use for their own purposes. For full details, see our privacy policy.

If you have any questions, please don’t hesitate to get in touch with us at chaos@diverseabilities.org.uk or 01202 718238 (option 3)