SJDH Holiday Club Registration 2017
Full name of child (and 'known by' name, if different) *
Your answer
Date of birth: *
MM
/
DD
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YYYY
School attended:
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Year group (if applicable)
Name of the person(s) who have parental responsibility for the child: *
Your answer
Address: *
Your answer
Landline:
Your answer
Mobile *
Your answer
E-mail *
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Emergency contact:
Your answer
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