Registration Now Open!

Child's Full Name *

Date of Birth *

School Class *

Address *

Postcode *

Home Phone *

Mobile *

Email *

What church do you attend (if any)?

Contact person (If parent unavailable) *

Relationship to child *

Home Phone *

Mobile *

Child's Doctor *

Doctor's Telephone *

Special Needs/Important Information

I will inform the leaders of any important changes to my child’s health, medication or needs, and of any changes to the addresses and phone numbers listed above. *

In the event of illness or accident, having personal responsibility for the above named child, I give permission for first aid to be administered where considered necessary by a trained first aider, if available, or medical treatment to be administered by a suitably qualified medical practitioner. If I cannot be contacted and my child should require emergency hospital treatment, I authorize an adult leader to sign on my behalf any written form of consent required by the hospital. However, I understand that every effort will be made to contact me as soon as possible. *

During the Holiday Bible Club photographs may be taken for general church purposes & the daily video recap. On signing this form we will assume you have given permission for your child’s photograph to be taken. *

If your child will walk/cycle to and from the club, and you wish them to be able to enter/leave without being signed in/out by an adult, please check the box. (We will also need verbal confirmation of this and will contact you by phone to verify your consent) *

Name of Parent/Guardian printed in full. *

I confirm that I have read the above and all details are correct to the best of my knowledge. *

Date *

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