Epic Explorers Application Form
Tuesday 28th-Friday 31st August, 9:30am-1pm,
Christ Church House, Christ Church Cockfosters.
For children in school years 2-6 (from September 2018).

Please fill in the form below. If you have any questions about the holiday club, please send an email to ccc.epic.explorers@gmail.com. Because spaces are limited, please return your forms by Sunday 5th August at the latest, to avoid disappointment. We will contact you to confirm your place on this exciting adventure. Registration will take place from 9:30am.

Email address *
Parent / Guardian's Details
Name(s) of parent/guardian: *
Address *
Landline phone number:
Mobile phone number:
School your child/children attend:
Child / Children's Details:
The cost of the holiday club is £20 per child. If you have a third or fourth child that you would like to attend, the rate reduces to £15 for the third child, and £10 for the fourth child (this contribution means we can provide quality drama, crafts, and an engaging set which will create a totally epic atmosphere!). The club is for children in school years 2-6 as of September 2018.
Child 1's Name: *
Child 1's Date of Birth *
Child 1's School Year (from September 2018): *
Child 2's Name:
Child 2's Date of Birth:
Child 2's School Year (from September 2018):
Child 3's Name:
Child 3's Date of Birth:
Child 3's School Year (from September 2018):
Child 4's Name:
Child 4's Date of Birth:
Child 4's School Year (from September 2018):
Other children's details (if you are applying for more than four children, please provide the same information as above here):
Medical and GP Details
Please give details of any health problems, medical conditions or allergies affecting your child / children, or any medication that they may be taking. All children will be expected to bring a packed lunch – we would like to ask you to make sure that this contains no nuts.
GP's name:
GP's telephone number:
GP's address:
Name of alternative emergency contact (i.e. in addition to parent's details given above):
Relationship to child:
Address of alternative emergency contact:
Telephone number of alternative emergency contact:
Mobile phone number of alternative emergency contact:
Please give us any other information that you think may be useful to us in caring for your child / children:
Consent
We will process the information you provide on this form in line with the requirements of General Data Protection Regulations (details of our policies cand be found here: http://christchurchcockfosters.co.uk/about/policies-procedures/)
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