Holiday Activity Registration form
Email address *
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Date Of Birth *
MM
/
DD
/
YYYY
Is there any medical information that we need to be aware of? (If none enter No) *
Your answer
Is there anything that we can do or say to help calm your child if they get stressed?
Your answer
Allergy Information - Please provide information on any allergies that we may need to be aware of as well as any treatment plans currently in place. This also applies to food allergies. If your child has no allergies please enter 'None' *
Your answer
Are you a Clayesmore Society Member? *
What is your Clayesmore Society Number?
Your answer
Parent/Guardian Contact Name *
Your answer
Contact Telephone Number (Including Area Code) Mobile Numbers accepted *
Your answer
Additional Contact Number in case of emergency *
Your answer
Are you happy for your child to be included in photos which may be used for promotional purposes including on social media pages? (We may want to take photos or videos of the holiday activities for promotional purposes including use on our Social Media Pages - Facebook, Twitter, etc. Clayesmore website and publications such as leaflets.) *
Can the child named above swim 50metres unaided
Is the child named above a current Clayesmore Pupil? *
A copy of your responses will be emailed to the address you provided.
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