Easter Holiday Club Registration 2018
For children in Reception up to Year 6
Email address *
Tuesday April 10th - Friday April 13th 2018, 9.30am-12pm
Child's name (1 child per form) *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Current School Year *
Name of current school *
Your answer
To attend SJS Easter Holiday Club on the following days *
Required
I understand the cost is £5 per day, payable at the start of Holiday Club *
Name of Parent/Guardian *
Your answer
Address *
Your answer
Phone contact during the club *
Your answer
Alternative emergency contact (Name + tel no) *
Your answer
Names of persons authorised to collect your child & relationship to child *
Your answer
Allergies, medical or dietary needs or any additional needs/information we should know. *
Your answer
Details of GP (doctor's name, address & tel no) *
Your answer
I am happy for my child to be looked after by church volunteers, who may act in my place in loco parentis & to join in the activities arranged at Holiday Club. *
In the unlikely event of illness or accident, I give permission for the nominated trained 1st aider to give necessary treatment (e.g. sting/bite cream, plaster, antiseptic solution). In an emergency & if I can not be contacted, I am willing for my child to receive hospital treatment. I understand every effort will be made to contact me as soon as possible. *
We will be taking photographs & video footage of the club for use within church publicity and events only. I give permission for my child to be in these. *
I would like to be contacted regarding upcoming events at SJS (all personal details will be kept confidential & won't be shared with anyone). Please state preference of email or postal address. *
I understand that I will have to pay £5 for each day attended at the start of the club (or sent in beforehand to the church office). Cheques payable to 'St John’s Stoke-next-Guildford' *
Required
A copy of your responses will be emailed to the address you provided.
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