East London Basket Ball Camp
Event Timing: August 15th - 17th , 2016
Event Address: Raines Foundation Upper School, Bethnal Green, E2 9LY
Contact us on 07587 049 080 or elbc@eltbaptistchurch.org
Details
First and Last Name
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Date of Birth
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Telephone Number
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School
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Home Address
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School Year
Please tell us any details of any special educational needs that the child named above has:
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Please indicate any allergies the child named above has (please include any medication required):
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Tshirt size (please state if this is in child or adult sizing):
Name of parent/carer (must be over the age of 18):
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Relationship to child named above:
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Parent/carer contact number:
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Emergency contact number and name if different from the named parent/carer above:
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Email:
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Emergency contact number and name if different from the named parent/carer above:I do/do not give my permission for the child named above to leave the camp alone (please delete as appropriate)
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