Summer Holiday Club Booking Form 2017 Please book your place using the online booking form below Name of child* First Last Child's date of birth*Name of parent/guardian* First Last Is your child a pupil at Portsmouth High School?* Yes No Address (for children who are NOT current pupils) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Contact telephone number*Email address* Week One - Sports Camp 9.00am to 4.00pm Monday 31 July Tuesday 1 August Wednesday 2 August Thursday 3 August Friday 4 August Sports Camp is for children aged 3 to 11. For attendance from 9.00am to 4.00pm the cost is £30 per day or £140 per week.Week One - Sports Camp 8.00am to 5.00pm Monday 31 July Tuesday 1 August Wednesday 2 August Thursday 3 August Friday 4 August Sports Camp is for children aged 3 to 11. For attendance from 8.00am to 5.00pm the cost is £35 per day or £160 per week.Week Two - Creative Arts 9.00am to 4.00pm Monday 7 August Tuesday 8 August Wednesday 9 August Thursday 10 August Friday 11 August Creative Arts is for children from ages 3 to 11. For attendance from 9.00am to 4.00pm the cost is £30 per day or £140 per week.Week Two - Creative Arts 8.00am to 5.00pm Monday 7 August Tuesday 8 August Wednesday 9 August Thursday 10 August Friday 11 August Creative Arts is for children from ages 3 to 11. For attendance from 8.00am to 5.00pm the cost is £35 per day or £160 per week.Total amount to pay*Please indicate how you would like to payCheque (Payable to Portsmouth High School)Child care vouchersBACS (Account code 24060666, sort code 60-04-04)AGORA (PHS pupils only)Worldpay (Telephone our Finance Officer on 023 9282 6714)Please return cheques (made payable to Portsmouth High School) to Mrs Michelle Mangnall, Portsmouth High Junior School, 36 Kent Road, Southsea, Hampshire PO5 3ES. Please clearly indicate your name and the name of your child when you send in your cheque. This iframe contains the logic required to handle Ajax powered Gravity Forms.