HOLIDAY BIBLE CLUB 2019 Registration and Consent Form
22nd - 26th July 2019

9.30am - 12.30am

P1 - Year 8

£15 per child (Registration not complete until payment is received)

Please use one form per child.

Email address *
Child's Full Name *
Your answer
Date Of Birth *
Your answer
Name of Parent/Guardian *
Your answer
Address 1 *
Your answer
Address 2
Your answer
Town *
Your answer
Postcode *
Your answer
Home Phone Number
Your answer
Mobile Phone Number *
Your answer
Emergency Contact Name (If above unavailable) *
Your answer
Emergency Contact phone number *
Your answer
GP's Name *
Your answer
GP's phone number *
Your answer
Any known allergies or conditions including special educational needs *
Your answer
I give permission for my child's details to be entered onto the Church database *
I give permission for photographs and videos to be taken during the week of activities and used on church publications (eg Website, Social Media, Pew News) *
In the event of illness or accident, I give permission for any appropriate first aid to be given. In an emergency, and if I cannot be contacted, I am willing for my child to be given hospital treatment. I understand that every effort will be made to contact me as soon as possible. *
Signed: (Name of Parent/Guardian) *
Your answer
Date *
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DD
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YYYY
A copy of your responses will be emailed to the address you provided.
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