Holiday Club

Summer Holiday Club 2018
Registration Form

Please fill in this form to book a place for your child.
A separate form is required for each child.

* Indicates required field

Dates when the child will be attending *

Name of child *

First

Last

Gender *

Date of birth *

Name of the school attending *

Please give details of any of the named child’s medical conditions (eg. allergies, asthma, epilepsy, diabetes, dietary needs) or disability that may affect this activity. *

Name of parent/carer *

Address *

E-mail *

Telephone *

I give permission for details from this form to be entered onto the church database. *

Yes No

I give permission for my child's photograph to be taken during the club *

Yes No

PLEASE NOTE:

A Child Collection Slip will be given to you when you leave your child with us. For your child’s protection it must be produced when you or someone else comes to collect them. We cannot allow them to leave with anyone else unless you phone 020 8554 7488 with your permission.
This consent form will be kept by the responsible Church Worker on the activity. Photographs of this activity will be taken for display within the church.
Your form submission will be acknowledged within 5 working days.

Submit form

﻿﻿Summer Holiday Club 2018Registration Form

Summer Holiday Club 2018
Registration Form