Kingsmoss Summer Club Registration

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete a registration consent form for your child who is attending. If multiple children are attending from the same family, please complete a separate form for each child. Thank you.

Join us from Monday 10th - Friday 14th August at Kingsmoss Gospel Hall for our Summer Club. Each night from 6:30 - 8:00pm, all children aged 4+ would be most welcome! Children will enjoy team games, sports and crafts each evening, followed by a talk from the Bible, singing and quizzes. We provide the children with a small snack and drink after their activities. There will be a BBQ on the Friday night for all of your family to attend. Summer Club is free of charge and all leaders at the Summer Club are vetted with Access NI and trained in child protection. Please follow us on Facebook at 'Kingsmoss Gospel Hall' to keep up to date with reminders.

We look forward to seeing you there. Any further questions, please feel free to contact Laura on 07956458029, message us on our Facebook page (@KingmossGospelHall) or visit our website at kingsmoss.co.uk, thank you!

Email *

Child's Full Name *

Date of Birth *

YYYY

Child’s Home Address

Year group your child will be going into in September 2026 *

Primary 1

Primary 2

Primary 3

Primary 4

Primary 5

Primary 6

Primary 7

Year 8

Secondary School Age - Year 9 or older

Other (please specify at bottom of this form)

Contact 1 - Name of parent/guardian to be contacted in case of emergency *

Contact 1 - Relationship to child *

Contact 1 - Emergency Phone Number *

Contact 2 - Name of parent/guardian to be contacted in case of emergency, if contact 1 not available.
*

Contact 2 - Relationship to child
*

Contact 2 - Emergency Phone Number
*

Please indicate medical conditions, additional needs, allergies or dietary requirements relevant to your child.

Please outline any relevant medication being taken or anything else you think may be relevant for leaders to know whilst your child is in our care. We give the children a small snack each night, please let us know of any dietary requirements.

In the event of illness or accident, having parental responsibility for the above named child, I give permission for first aid to be administered where considered necessary by a first aider, if available, or medical treatment to be administered by a suitably qualified practitioner.

*In the event of a medical emergency, a leader will endeavor to contact you as soon as possible using the contact telephone numbers given.

*I will inform a leader of any important changes to my child's health, medication or any phone numbers given above

I agree with the statements above and all details I have provided are correct.

I give Kingsmoss Gospel Hall permission to contact me via the email address provided about Summer Club and any children's activities taking place in the future that would be relevant to me. *

Yes I give permission to contacted via email

No I do not want to be contacted

Signature

(Please type your full name to give your permission for your child to attend Kingsmoss Summer Club)

Anything else you wish for us to know? This is not a required question, so you do not need to fill in an answer to this question.

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms