St Andrew's Bible Holiday Club 2019

                                  Booking and Registration Form

Child's Name:

Full Address:

Tel No:

Date of Birth:

School Year just completed:

Emergency contact details:

Details of any allergies, conditions or special needs, including medication:

Do you give permission for the church to keep these details on the church
database for future events?  Yes  No

Do you give permission for photographs of your child to be taken during
the club and possibly used for future displays in the church or in church
publications or on the church website?  Yes  No

I confirm that the above details are complete and correct to the best of my
knowledge. In the unlikely event of illness or accident, I give permission
for any appropriate first aid to be given by the nominated first-aider. In an
emergency and if I cannot be contacted, I am willing for my child to be
given hospital treatment, including anaesthetic if necessary. I understand
that every effort will be made to contact me as soon as possible.

Please note that you will need to sign your child/children in and out each day.

Name of Parent or Guardian:

Your email Address:


Please complete and submit by 19th July: