Holiday Club booking form

'Awesome' Holiday Club 2017

Places will be allocated on a first come, first served basis.

We will contact you only if we are unable to give your child a place.

For further information, recheck the details here or contact Andrea Woods 07526 728301 or by email.

Organised by the churches of St Andrew’s and Christ Church Eaton

St Andrew's Charity Number: 1130712

Christ Church's Charity Number: 1130553

 

 

                                                                                                             


Full name(s) of child(ren):*
Date(s) of birth:*
School(s):*
Any known allergies or conditions :
Address:*
Telephone number(s):*
Email:*
Emergency contact name:*
Emergency contact telephone number:*
GP's name:*
GP's telephone number:*
I give permission for the information from this form being submitted through the website and being entered on the church database (if not please contact Andrea separately and do not book online):*
Yes
I give permission for St Andrew’s and Christ Church to email me about future events for children and families.:*
Yes
No
I give permission for my child(ren)’s photograph to be taken during the club (the photographs will be used to create a display in church or on the website for a short period after this event.):*
Yes
No
Number of (a) adults and (b) children wishing to join the lunch after the holiday Club service on Friday 28th :
In the unlikely event of illness or accident I give permission for any appropriate first aid treatment to be given. :*
Yes
In an emergency, and if I cannot be contacted, I give consent for my child(ren) to receive treatment by a GP and/or hospital, including treatment under general anaesthetic. I understand that every effort will be made to contact me as soon as possible:*
Yes
We try to keep school year groups together but it is not always possible. If there is a friend your child would like to be with please tell us:
I confirm that the above details are correct to the best of my knowledge.:*
Yes
Parent's/Guardian's full name:*
Payment method:*
Cheque
BACS
Please enter the verification number on the right:*
Five Free Too Five Six
* Required Fields