Holiday Club Registration Form Holiday Club Registration and Consent Form Register your child(ren) for The Light Fantastic, half term holiday club with St George's Church and Hope Church. 21st - 23rd October, 9.30 - midday at The Shirley Centre, CB4 1TF Family Details:Child's Full Name* First Middle Last Date of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Full Name of Parent/Guardian* First Last Home Address* Street Address Address Line 2 City ZIP / Postal Code Home PhoneParent/Guardian's Mobile Phone*Parent/Guardian's Email* Enter Email Confirm Email Family Doctor* Please Include Name and Practise Which School Does Your Child Attend* Name of School Which school year is your child in?* Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 About Your Child:Does Your Child Have Any Food Allergies* Please specifyDoes Your Child Have Any Medical Conditions?* Please specifyIs your child on any medication?* Please specifyNHS number* Details of last anti tetanus injection* Does your child have any special needs?*Is there anything else you would like us to know about your child?Consent for PhotographsUse of photographs of children and young people from activities or events in official church publications, or from the church's social media, website and displays. If you do not wish this to happen, you will not be asked for an explanation and your request will be respected. If you do not tick the box to say you do not give permission then it will be presumed that permission is granted. I do not give permission for picures to be takenEmergency Contact DetailsPlease give contact details for parents/guardiansContact telephone during group or activity time* Contact name for carer/an alternative adult in case of emergincies* please provide a telephone number and the relationship of that person to you/your child.Arrangements for collectionMy child will be collected by:* please specify relationship to you/your childName of anyone NOT allowed to collect your child? Please specify name of person and their relationship to you/the child.My child has permission to travel to and from the group without meThis for children over 11 years of age. Yes No DeclarationI give permission for my child (as named on this registration form) to attend and take part in the specified activities.* I agreeIn an emergency and/or if I am not contactable, my child can receive doctor, hospital or dental trematment including an anaesthetic.* I agree I do not agree Please date this form.* MM slash DD slash YYYY Please sign this form to confirm permission for the above named child to attend The Light Fantastic* The information requested on this form can be completed by a carer, but only those with parental responsibility can sign the consent (NB This may not include a foster carer).
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