Holiday Club in a day

Holiday Club in a Day is coming!

Wednesday, October 30th

10 am to 12:30 pm.

Free fun for all primary school children.

The information given on this form will not be passed on to any other person or organisation, but may be used to contact you to ask for feedback or keep you informed of any future events.

Child's Name *

Child's Name

First Name

Last Name

Child's date of birth (dd/mm/yyyy)

Child's age on 30th October 2019 *

Gender *

Address *

Postcode *

Parent/Legal Guardian's Name *

Email Address

Home Phone Number *

Mobile Phone Number

Emergency Contact Name and Number *

Details of any known medical conditions, allergies etc. or taking any medication that we should know about:

GP *

How did you hear about holiday club? *

The Beacon (Backwell church newletter delivered to houses in Backwell)

Facebook

Word of mouth

Local paper

School

Summer holiday club leaflet

Other

In the event of an emergency or non-emergency situation requiring medical treatment I am willing for my child to receive necessary medical attention until such a time as I can be contacted: *

I give permission for photographic images of my child to be taken (The photographs will be used for church purposes only, including powerpoints and press releases.) *

I give permission for my child to take part in normal activities, including activities outside the building, of this Holiday Club: *

Yes

Is there anything else you think we need to know?

The information given on this form will not be passed on to any other person or organization, but may be used to contact yourself to ask for feedback or keep you informed of any future events.