Registration Form
Pyramid Rock Holiday Club

Monday 8th August to Friday 12th August 2022
10am–12.15pm each day

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

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


Child's Name:*
Gender:
M
F
Date of birth:*
Primary Class in August 2022:*
Any days child NOT attending Holiday Club?:
Monday
Tuesday
Wednesday
Thursday
Friday
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
No
In the event of illness or accident I give permission for first aid to be given by the nominated first-aider:*
Yes, I give permission
No, 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:*
Yes, I give permission
No, I do not give permission
I give permission for my details and those of my child to be entered into the church database:*
Yes, I give permission
No, I do not give permission
I give permission for my child's photographs to be used in Greenbank online and printed publications:*
Yes, I give permission
No, I do not give permission
How did you hear about the Greenbank Holiday Club?:
Please enter the verification number:*
four four three six two
* Required Fields