Holiday Club 2018 - Registration
Join us for this years holiday club where we'll be exploring
Guardians of Ancora 2 - Treasure Seekers.

August 13th - 17th
10.00 am -12.30 pm Monday - Friday
Holiday Club is for Primary school age only: Reception - Year 6

At St. John’s Church
1 The Furrows
Walton-on-Thames

For more information and enquiries contact Mandy on 07956295113 or email mandy@waltonparish.org.uk
This form will reserve your child a place.
Places will be confirmed by telephone.
Please fill out a separate form for each child you wish to register.

Your child's name *
Your answer
Your name *
Your answer
Your telephone number *
Your answer
Your address *
Your answer
Your Email *
Your answer
Your relationship to the child *
Your answer
Your child's age and date of birth *
Your answer
Your child's school and year group *
Your answer
Name of emergency contact and relationship to child.
Your answer
Second emergency contact name, number and relationship to child.
Your answer
What days will they attend? *
Required
Dietary restrictions *
Special needs, including allergies, medication and anything else you think we might need to know e.g. 1:1 or other extra help at school, food allergies etc
Your answer
Doctor's name & tel no
Your answer
The week is free of charge and all costs are met by the Church. PLACES ARE LIMITED. *
Required
I give permission for my child to take part in activities at the ’Guardians of Ancora’ Holiday Club’ at St. John’s Church.I agree to any emergency medical treatment to be given as considered necessary by the medical authorities if I cannot be contacted. NB. The medical profession takes the view that a parent’s consent to medical treatment cannot be delegated. Medical consent forms have no legal status and a doctor has the right to insist on parental consent before treating a child. We have found, however, that medical staff find this type of general consent helpful. *
Required
If you will not be collecting your child, name of person authorised to collect your child on your behalf:
Your answer
We will be taking pictures of the event and activities, do you give permission for your child’s picture to be in any of our publicity, (this may include the Church website and Social Media). Please tick below or speak to Mandy for further details. *
Required
By completing this form I am giving consent to all the above as indicated by my answers. *
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We would love to stay in touch with you. If you would like to be informed of future events and other church news please tick the box below. You can unsubscribe at any time, either by clicking on the unsubscribe link at the bottom of our emails, or by contacting the Parish Office - office@waltonparish.org.uk For further information see our Privacy Notice which can be found on the website. *
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