For young people with a learning disability from South Wiltshire
Thursday 16 February
10.15am – 2.45pm
15-25 year olds
Stratford Road Social Club, Salisbury, SP1 3JP
COME and join in the excitement of our February Fun Day
Snack and drink
Fun activities to be confirmed
Reflection time to plan 2017 fun days
Please bring a healthy packed
All great fun… cost £10.00 per person*
*Please note that lunch is not provided.
Send your completed form and cheque (payable to South Wilts Mencap) to;
February Fun Day, c/o Angela Ockenden, Mencap Shop, 16 Catherine Street, Salisbury, SP1 2AD.
CLOSING DATE: Sunday 12th February.
Please could you arrive at 2:30pm to collect as the hall is booked by another group at 3pm.
BOOKING FOR Feel Good February Fun Day, Thursday 16 Feb 2016
Young person’s name: Age:
Address including Post Code:
Parent /Carer Name:
Contact Numbers of Parent /Carer including mobile no:
Parent /Carer Address if different from above:
Is any Medication required whilst attending? Yes / No
If yes – what is the medication name and dosage?
Does s/he use a mobility aid? Yes / No Wheelchair, frame or stick
Is the young person diabetic? Yes / No Epileptic? Yes / No
Any food allergies? Please detail:
GP’s Name & Surgery:
Surgery contact number:
Have we consent to take photographs and record film footage to use for our charity purposes?
Yes / No