2019 Holiday Club Registration Form
Please register up to 3 children for Lionheart and the Great Wild West Adventure !
For more than 3 children, please use the registration link again to submit an additional form.
Email address *
Surname *
Your answer
How many children are you submitting? *
Child 1- Name *
Your answer
Child 2 - Name
Your answer
Child 3 - Name
Your answer
Which days do you want child 1 to attend: *
Required
Which days do you want child 2 to attend:
Please complete for 2nd child
Which days do you want child 3 to attend:
Please complete for 3rd child
Date of birth 1 *
MM
/
DD
/
YYYY
Date of birth 2
Please complete if registering a 2nd child
MM
/
DD
/
YYYY
Date of birth 3
Please complete if registering a 3rd child
MM
/
DD
/
YYYY
School year is your child in 1 *
School year is your child in 2
Please complete if registering a 2nd child
School year is your child in 3
Please complete if registering a 3rd child
Address *
Your answer
Telephone Number *
+441234567890 (please use '+44' instead of 0)
Your answer
Emergency Telephone 1 *
+441234567890 (please use '+44' instead of 0)
Your answer
Emergency Telephone 2
+441234567890 (please use '+44' instead of 0)
Your answer
Doctor's Telephone Number *
+441234567890 (please use '+44' instead of 0)
Your answer
Does your child have known medical conditions? If you use an inhaler, EpiPen, or other medication please bring it with you. *
Put N/A if not applicable
Your answer
I agree to emergency treatment to be given as considered necessary by the medical authorities if I cannot be contacted. *
Required
I agree to photographs of activities including my child to be taken and to be used within the community *
I accept that Eastbury Church may hold my information given here, for the purpose of running holiday club, and in accordance with the principles of GDPR. Please tick to accept. *
We hold this information in our Google account, accessed only by leaders organizing holiday club.
Required
Do you want to be contacted about next year's Holiday Club or other events? *
A copy of your responses will be emailed to the address that you provided. When you receive this you can be sure that your children are registered, and we look forward to seeing them in April.
A copy of your responses will be emailed to the address you provided.
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