Summer Holiday Club 2021

SUMMER HOLIDAY CLUB
Booking Form
August 9-11, 2021
NB: Children will need a pack lunch (drinks and snacks will be provided) ** PLEASE COMPLETE ONE FORM PER CHILD **
Child's full name including surname(*)
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Age(*)
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Contact information
Which date will your child be attending?(*)
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Names and contact details of all parents and Carers with parental Responsibility:
Parent/carer 1
Name(*)
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Address(*)
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Mobile number(*)
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Home phone number(*)
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Work phone number(*)
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Email(*)
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Parent/carer 2
Name
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Address
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Mobile number
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Home phone number
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Work phone number
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Email
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Medical Information Please inform us of any relevant medical information e.g. allergies, dietary needs (*)
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If you would like to be informed of future events and other church news please tick the box (*)
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I give permission for any quotes from the above child to be included in any promotional material(*)
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I give permission for this child to receive urgent medical treatments (*)
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I give permission for the above child to be included in promotional photographs which may be taken(*)
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I give permission for the information completed on this form to be held on record by Severnside Parishes(*)
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Church of England behaviour and equal opportunities policies and procedures will be observed throughout the course of the Holiday Club
Your name(*)
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Relationship to child(*)
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Date(*)
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Submit

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