Use this form to register your child or children for the
Greenbank Parish Church Christmas Event for Primary School Age Children,
to be held on Saturday 9th December 2017 from 1.30pm to 4.30pm

You can register up to four children using this form.
The children must all live in the same household.
When registering a child, all the fields for that child must be completed.
Where fewer than four children are being registered, leave all subsequent children's fields blank.

Later on, if you pay by PayPal please select the number of children you register below.


1st Child's Name:*
1st Child's Gender:*
M
F
1st Child's date of birth:*
1st Child's Primary Class in August 2017:*
1st Child: Any known allergies or conditions?:*
2nd Child's Name:
2nd Child's Gender:
M
F
2nd Child's Date of Birth:
2nd Child's Primary Class in August 2017:
2nd Child: Any known allergies or conditions?:
3rd Child's Name:
3rd Child's Gender:
M
F
3rd Child's Date of Birth:
3rd Child's Primary Class in August 2017:
3rd Child: Any known allergies or conditions?:
4th Child's Name:
4th Child's Gender:
M
F
4th Child's Date of Birth:
4th Child's Primary Class in August 2017:
4th Child: Any known allergies or conditions?:
Parent/Guardian's Name and Address:*
Telephone Number:*
Mobile Number:*
Email Address:*
Children's GP's Name, Address and Telephone Number:*
I confirm that the above details are complete and correct to the best of my knowledge:*
Y
N
In the event of illness or accident I give permission for first aid to be given by the nominated first-aider. In an emergency, and if I cannot be contacted, I am willing for my children 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 children to be entered into the church database:*
Yes, I give permission
No, I do not give permission
I give permission for my children'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 Christmas event for Children?:*
Advert in local magazine
In Greenbank Connections newsletter
Poster in Church premises or elsewhere
Flyer brought home from School
From an organisation that meets at Greenbank
By word of mouth
Other
Please enter the verification number on the right:*
six five five seven seven
* Required Fields