Explorers Holiday Bible Club 2015
Registration Form for Explorers Holiday Bible Club from Monday 17th August to Friday 21st August from 10:30am - 12:30pm

Please fill in this form as best as you can - for Child Protection reasons we will need you to sign a short form on the first day to confirm all details are correct and as stated here.

Please fill in a separate form for each child.

Thank you! We look forward to seeing you there on the 17th August!
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Name of child *
If you could write the full name e.g. Peter William Graham
Preferred Name *
e.g. Pete
Postal Address of place child lives *
Date of Birth *
Age of child as of Monday 17th August 2015 *
Unfortunately we cannot accept registrations for children who are younger than Primary School Age (as of September 2015)
School child attends (as of 1st September 2015) *
What school class will your child be going into in September 2015? *
Parent(s) or Guardian(s) Name *
First Name and Surname is fine e.g. Joe Smith and Jill Brown
Email Address of Parent/Guardian
Phone Number of Parent/Guardian
Emergency Contact 1 - Contact Name *
Needs to be someone we can contact in case of emergency during the Holiday Bible Club
Emergency Contact 1 - Preferred Contact Number *
Needs to be a number we can contact in case of emergency during the Holiday Bible Club
Emergency Contact 1 - Alternative Contact Number *
Used if we cannot get in contact using the preferred contact number
Emergency Contact 1 - Relationship to child *
e.g. Grandparent, Childminder etc
Emergency Contact 2 - Contact Name *
Used if we cannot get in contact with Emergency Contact 1
Emergency Contact 2 - Preferred Contact Number *
Emergency Contact 2 - Alternative Contact Number *
Emergency Contact 2 - Relationship to child *
e.g. Grandparent, Childminder etc
I give permission for [my child’s name] to attend the ‘Explorers Holiday Bible Club’ meeting on the days and times specified above and to participate in all the activities of the organisation, and know of no medical reason why he/she should not do so. It is my understanding that my specific consent will be sought for any additional activity outside the above days and times and venue. *
Does your child have any medical condition/allergies (specifying any medication he/she may be taking) and/or has any special dietary requirements about which the leaders of the Holiday Bible Club should be informed? If your child has none such conditions/medicine/allergies or dietary requirements please write 'None known' rather than leaving blank) *
Please include as much details as possible so that we can ensure your child can enjoy the Holiday Bible Club to the utmost potential.
I give permission for the basic first-aid to be administered to my child if required *
In the event of he/she being taken ill during Holiday Bible Club in which surgical operation or serum injection becomes necessary, I hereby authorise the leader in charge (Pete Graham, Youth Ministry Co-ordinator) to sign on behalf any written consent forms required, provided the delay necessitated to obtain my signature might endanger his/her health or safety. *
I give permission to allow photographs or videos to be taken of my child in the context of the organisation activities for the sole use in the parish magazine, church publicity and/or the church website *
I give permission to be contacted about other youth and parish events by email *
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