REGISTRATION FORM FOR “MISSION RESCUE” HOLIDAY CLUB

Tue 23rd July to Fri 26th July 2019 10.00 am – 12.00 noon

Please enter all the information required in the form below. Families with more than 3 children will need to fill out a separate form for the remaining children.

PLEASE NOTE ALL FIELDS MARKED * ARE REQUIRED AND MUST BE FILLED IN
DO NOT LEAVE ANY BLANK OR ALL INFORMATION ENTERED WILL BE LOST

Child's Details

Child’s First Name *
Child’s Last Name *
Child’s Date of Birth *
Child’s Current School Year *
Health Information *
Enter any medical conditions, disabilities, allergies, dietary needs, special needs. Specify None if none.

Add a Second Child

Child’s First Name *
Child’s Last Name *
Child’s Date of Birth *
Child’s Current School Year *
Health Information *
Enter any medical conditions, disabilities, allergies, dietary needs, special needs. Specify None if none.

Add a Third Child

Child’s First Name *
Child’s Last Name *
Child’s Date of Birth *
Child’s Current School Year *
Health Information *
Enter any medical conditions, disabilities, allergies, dietary needs, special needs. Specify None if none.

Parent/Carer Contact Details

Parent/Carer’s First Name *
Parent/Carer’s Last Name *
Address *
Postcode *
eMail Address *
Contact Telephone Number *
Emergency Telephone Number *

Consents

In the unlikely event of illness or accident, I give permission for any necessary medical treatment to be administered by the nominated first aider, or by qualified medical practitioners. Should my child/children require emergency hospital or dental treatment, I authorise the adult leader to give consent or sign for this treatment. I understand that every effort will be made to contact me as soon as possible.

Tick here to indicate your consent to the statement above *

I give consent for photos to be taken of my child/children during the Holiday Club

I give permission for these photos to be displayed in the church or the hall used for the Holiday Club

I give permission for these photos to be used in the local newspapers

Nominated Adult 1's Details

Details of an additional adult that may drop off or pick up your child. Please fill in all the fields if specifying someone.

Nominated Adult’s First Name
Nominated Adult’s Last Name
Nominated Adult’s Contact Tel.
Nominated Adult’s eMail Address

Nominated Adult 2's Details

Details of an additional adult that may drop off or pick up your child. Please fill in all the fields if specifying someone.

Nominated Adult’s First Name
Nominated Adult’s Last Name
Nominated Adult’s Contact Tel.
Nominated Adult’s eMail Address

Declaration & Personal Data Preferences

Please keep me informed of any other activities for children and families at Bourne Baptist Church

I would like my email address to be added to the Bourne Baptist Church events mailing list

I DECLARE THAT ALL OF THE INFORMATION GIVEN ABOVE IS CORRECT AND I GIVE MY PERMISSION FOR MY CHILD/CHILDREN TO PARTICIPATE IN THE HOLIDAY CLUB

Tick here to indicate your consent to the statement above (required) *

PLEASE NOTE ALL FIELDS MARKED * ARE REQUIRED AND MUST BE FILLED IN
DO NOT LEAVE ANY BLANK OR ALL INFORMATION ENTERED WILL BE LOST