• Holiday Club 2019

    Registration and Consent Form

  • We're looking forward to welcoming you to this year's Wild, Wild West Holiday Club. You're sure to have a Rootin' Tootin' time.

    This year the club runs from Monday 8th to Friday 12th April and starts at 10am to 12pm each day. We'll have all of our usual activitities: games, crafts, stories, songs and, of course, GUNGE!

    Sign up now for a whole week of fun and games!

  • Child's Details

  • Gender*
  •  / /
  • Does your child have any allergies or medical conditions we should know about?*

  • Consent

  • I give permission for my child to have their face painted, if they wish*
  • I give permission for my details to be entered on the church database*
  • I give permission for my child's photograph to be used in church publications*
  • Would you like to register another child?*

  • Child #2's Details

  • Gender*
  •  / /
  • Does your child have any allergies or medical conditions we should know about?*

  • Consent

  • I give permission for my child to have their face painted, if they wish*
  • I give permission for my details to be entered on the church database*
  • I give permission for my child's photograph to be used in church publications*
  • Would you like to register another child?*

  • Child #3's Details

  • Gender*
  •  / /
  • Does your child have any allergies or medical conditions we should know about?*

  • Consent

  • I give permission for my child to have their face painted, if they wish*
  • I give permission for my details to be entered on the church database*
  • I give permission for my child's photograph to be used in church publications*

  • Parent/Gaurdian

  • Emergency Details

  • Do you want to provide different details to those already given?*

  • I confirm that the details provided are complete and correct to the best of my knowledge.

    In the unlikely event of any illness or accident I give permission for any necessary medical treatment to be given by the nominated first-aider(s).
    In an emergency and if I cannot be contacted, I consent to my child receiving hospital treatment, including anaesthetic if necessary.
    I understand that every effort will be made to contact me as soon as possible.

  • You will now be taken to the payment page. If you do not want to pay using PayPal please click 'No', you will then be able to submit or print your form.

    If you prefer not to use PayPal please make a note of your reference number below and pay at the church office or on the first day of holiday club at the latest.

  • Do you want to proceed to payment?*
  •   

  • Payment

  • prevnext( X )
    GBP

  • After pressing submit, you will be taken to the PayPal website for payment to be taken, after which your form will be submitted.

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