Going Bananas Registration Form
Child's Full Name *
Male/Female *
Date of Birth *
MM
/
DD
/
YYYY
School *
School year (starting in August) *
Parent/Guardian's Full Name: *
Email *
Address *
Contact Phone Number *
Emergency Contact Name *
Emergency Contact Phone Number *
GP's Name & Surgery *
GP's Phone Number *
Any known allergies or conditions *
Photographs of the children may be taken during some of our activities to show during our Sunday Family Celebration and on our website. Please indicate here if you are willing for your child to be photographed for these purposes. I give my permission for my child to be photographed: *
Required
My child may go home on his/her own after the club: *
I CONFIRM THAT THE ABOVE DETAILS ARE COMPLETE AND CORRECT TO THE BEST OF MY KNOWLEDGE. In the unlikely event of illness or accident. I give permission for any appropriate first aid to be given by the nominated first-aider. In an emergency, and if I cannot be contacted, I am willing for my child to be given hospital treatment, including anaesthetic if necessary. I understand that every effort will be made to contact me as soon as possible. *
We would like to keep your contact details to let you know of other future events for children and families. We will never give them to anyone else. Please confirm if you are happy for us to do this: *
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