Holiday Club Registration & Consent Form

Child's Name *

Date of Birth *

Gender

Male
Female

Home Address *

School *

Primary at June 2023 *

Any known allergies, dietary needs or health problems (juice & biscuits to be served daily)

If you are registering more than one child, please enter their names, date of birth and gender and any dietary requirements here

G.P.'s Name *

G.P. s Phone *

Parent/Guardian's Name *

Phone *

Mobile *

Email *

Alternative Emergency Contact Name *

Phone *

Mobile *

My child may be collected by

In the event of illness of 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 every effort will be made to contact me as soon as possible.

Name of parent or adult with parental responsibility *

Date *

Please tick the box if you are happy for us to use photos of your child taken at The Great Glen Green Welly Gardening Show 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

Photo Permission

Would you like to receive information regarding future events at Stirling North.

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