Child's Details

Child's Full Name

Child's Age

Childs Primary

Child's Primary School

Does your child have allergies or medical needs? (if yes, we will contact you via email for more info)

Child's Address

Emergency Contact Details

Parent or Guardian full name

Phone number

Relationship to child

Parent or Guardian address

Parent or Guardian email

There will be photography/filming at the holiday club Do you give consent for your child to be photographed/filmed? (the photos may be used on our church website and in promotional materials)

yes

Any other information you would like to share with us?

I confirm that all the information I have given in this form is correct and I will inform the leaders as soon as possible if there are any changes in any of the information I have given in this form