Holiday Club Registration Form

Child's name *

First

Last

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Date of birth

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School *

Primary at June 23 *

Do you wish to register another child?

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Doctor's Name

Doctor's Phone

Allergies or Medical Conditions

Additional support needs- in order to support every child to enjoy our holiday club, please detail any additional support needs so we can plan appropriately and we will endeavour to support

Home Address *

Address Line 2

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Town/City *

Postcode *

Parent's/Guardian's Name *

First

Last

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Phone *

Email *

Alternative Emergency Contact Name *

First

Last

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Phone *

Email *

My child (children) may be collected by

Parental Consent - In the event of illness or accident, I give permission for any necessary medical treatment to be given by the nominated first-aider. In an emergency and if I can't be contacted, I am willing for my child to receive hospital treatment, including anaesthetic if necessary. I understand that every effort will be made to contact me as soon as possible. *

Photographic permission - please let us know if you are happy for us to use photos of your child taken at the Holiday Club to be used for this church's publicity ( including our Facebook page). Photos will always be respectful in their nature with no link between your child's image and their personal details. *

We would like to send you information regarding future events at Stirling North

Date *

The information supplied on this form will be kept securely by our church on a database and only used for church related activities. It will not be disclosed to any third parties. Our privacy policy can be viewed our church website (stirlingnorth.org). You can withdraw consent at any time by contacting our Data Protection Officer (info@stirlingnorth.org)

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