HOLIDAY BIBLE CLUB 2019 Registration and Consent Form

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22nd - 26th July 2019

9.30am - 12.30am

P1 - Year 8

£15 per child (Registration not complete until payment is received)

Please use one form per child.

Email *

Child's Full Name *

Date Of Birth *

Name of Parent/Guardian *

Address 1 *

Address 2

Town *

Postcode *

Home Phone Number

Mobile Phone Number *

Emergency Contact Name (If above unavailable) *

Emergency Contact phone number *

GP's Name *

GP's phone number *

Any known allergies or conditions including special educational needs *

I give permission for my child's details to be entered onto the Church database *

Yes

I give permission for photographs and videos to be taken during the week of activities and used on church publications (eg Website, Social Media, Pew News) *

Yes

In the event of illness or accident, I give permission for any appropriate first aid to be given. In an emergency, and if I cannot be contacted, I am willing for my child to be given hospital treatment. I understand that every effort will be made to contact me as soon as possible. *

Yes

Signed: (Name of Parent/Guardian) *

Date *

YYYY

A copy of your responses will be emailed to the address you provided.

Submit

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