Holiday Club 2024 registration form

Registration Form
Rocky’s Plaice Holiday Club

Cost: £15 (£5 per day)
(indicate below any days child NOT attending)

Click here if you wish to pay online
for a child you previously registered.

You can register one child using this form.
Fields marked with a red asterisk must be completed.

Child's Name *

Gender

Date of birth *

Primary Class in August 2024 *

Any days child NOT attending Holiday Club?

Tuesday

Wednesday

Thursday

Known allergies or conditions (or reply NONE) *

Parent/Guardian's Name and Address *

Landline or Mobile Number *

Email address *

Emergency Contact (Name and Telephone Number) *

Child's GP's Name, Address and Telephone Number *

I confirm that the above details are complete and correct to the best of my knowledge *

Yes

In the event of illness or accident I give permission for first aid to be given by the nominated first-aider *

I give permission

I do not give permission

In an emergency, and if I cannot be contacted, I am willing for my child to be given hospital treatment, including anaesthetic *

I give permission

I do not give permission

I give permission for my details and those of my child to be entered into the church database *

I give permission

I do not give permission

I give permission for my child's photographs to be used in Greenbank online and printed publications *

I give permission

I do not give permission

I give permission for my child's photographs to be used on Greenbank's social media pages *

I give permission

I do not give permission

How did you hear about the Greenbank Holiday Club?

* Required Fields