Booking Form

Child's Information
Full Name
Date of Birth		Age
Address		Name of School
Postcode		Current School Year
Emergency Contact Details
Primary Contact		Secondary Contact
Name		Name
Relation to Child		Relation to Child
Address (if different from child)		Address (if different from child)
Telephone		Telephone
Mobile		Mobile
Medical Information
Does your child have any medical conditions or allergies?
Any other information that we might find helpful? (e.g. Learning Needs)
Has your child had any recent illness or injury?
Photography
Do you give permission for my child to have their photo taken during the club (photos taken may be used within church services, church magazine, the church website, social media and other promotional reasons - no names will be attached to photos).
Booking Days (£2.50 per day)
Monday: Tuesday:
Parental Agreement
I agree to the following terms and conditions: - It is your responsibilty to inform us of any changes to the information submitted on this form. - First Aid will be administered to the child named above by a first aider if necessary. - Please let us know as soon as possible if you wish to cancel any days.
Parent E-Mail Address