Registration Form

28th to 31st July (inclusive)
9.15am to 12.00 noon

REGISTRATION FORM

Name

Address

D.O.B. required

Parent/Carer Name

Contact Number

E-mail Address

Alternative Contact in case of emergency

Name

Contact Number

E-mail Address

Any medical conditions/disabilities we should be aware of?

Any allergies?

Any special dietary requirements?

Any other information we should be aware of?

Declaration of consent

I give my consent that if any emergency medical situation arises, Holiday Club volunteers may administer first aid and/or give consent on my behalf for other medical treatment and in the opinion of a qualified medical practitioner may be necessary. I also understand that in such circumstances all reasonable steps will be taken to contact me.

I give consent for photographs and videos to be taken of my child/children and used for display and publication purposes. This includes being posted on the Enon Baptist Churc website and or Facebook page.

I DO NOT give consent for photographs and videos to be taken of m child/children and used for display and publication purposes.

Your Signature

Print name

Thanks for submitting!