Please first fill in your name and email address, then fill in the correct information for your child.
Date of Birth
Name of School
Does your child have any medical conditions or allergies that we need to know about?
Parent/Guardian's Full Name
Parent/Guardian's Contact Number
Second Emergency Contact Name
Second Emergency Contact Number
It is really important for Treatz to be able to use photographic and video material for promotional purposes. Would you please tick to confirm your agreement to pictures being used of your child in the following way:
Promotional Literature (brochures and Flyers etc.)
Photographs on the websites and Facebook Pages of Kidz Klub, Dereham Baptist Church and Wellspring Family Church
Videos appearing on the websites and Facebook Pages of Kidz Klub, Dereham Baptist Church and Wellspring Family Church
It is also important to make you aware of other events that might be suitable for your child. By ticking the ministries below, you agree to them using your details send you promotional information about the events they are running:
Mid Norfolk Kidz Klub
Dereham Baptist Church
Wellspring Family Church
Do you confirm that the above details are correct, and agree to your child taking part in Treatz on 31st October 2018?
A copy of your responses will be emailed to the address you provided.
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