Enderby Summer Bible Club 2019
REGISTER YOUR CHILD FOR THE BIBLE CLUB (AUGUST 20th - AUGUST 22nd). COMPLETE A FORM FOR EACH CHILD ATTENDING.
Child's name: *
Your answer
Parent's name: *
Your answer
Parent's telephone / mobile number: *
Your answer
Parent's email: *
Your answer
Child's date of birth: *
Your answer
Child's address: *
Your answer
School year 2019 - 2020 *
Days attending: *
Required
Emergency contact number whilst at club: *
Your answer
Name of person collecting child at end of club: *
Your answer
My child has permission to travel to / from club without me: *
We may take photographs of children engaging in activities as a record of the club. Do we have your permission to include your child in this? *
Allergies, medication or dietary requirements? If none, please state: *
Your answer
If your child has dietary / medical requirements, please let us know what we will need to do to assist your child each day (eg. if your child's diet is restricted, let us know what they can eat, so that we can prepare appropriate snacks in advance):
Your answer
GP's name: *
Your answer
GP's number: *
Your answer
Does your child have any other needs which you feel we should know about in advance (eg. a special educational need such as ADHD or ASD); this is so that we can ensure your child is supported during their time at the club.
Your answer
Would you like us to contact you if there are similar events taking place in the future? *
Permission:
I hearby give permission for the child named to take part in all the activities at the Enderby Summer Bible Club. In the unlikely event of illness or accident I understand that every effort will be made to contact me. I give permission for any necessary medical treatment to be given, including first aid. In an emergency, I am willing for my son / daughter to receive hospital treatment, including anaesthetic. I will inform the leader caring for my child of any changes to the arrangements for collecting my child at the end of the club each day. I confirm that the details above are correct to the best of my knowledge.

SIGNED (required on the first day your child attends the club):.............................................................................................

DATE (added on registration):.............................................................

THERE IS NO PAYMENT REQUIRED FOR THE CLUB, HOWEVER THIS FORM MUST BE SIGNED ON THE FIRST DAY SO THAT YOUR CHILD HAS PERMISSION TO ATTEND

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