Child's Name:* |
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Gender: |
M
F |
Date of birth:* |
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Primary Class in August 2023:* |
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Any days child NOT attending Holiday Club?: |
Monday Tuesday Wednesday Thursday Friday |
Known allergies or conditions (or reply NONE):* |
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Parent/Guardian's Name and Address:* |
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Landline or Mobile Number:* |
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Email address:* |
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Emergency Contact (Name and Telephone Number):* |
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Child's GP's Name, Address and Telephone Number:* |
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I confirm that the above details are complete and correct to the best of my knowledge:* |
Yes
No |
In the event of illness or accident I give permission for first aid to be given by the nominated first-aider:* |
Yes, I give permission
No, I do not give permission |
In an emergency, and if I cannot be contacted, I am willing for my child 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 child to be entered into the church database:* |
Yes, I give permission
No, I do not give permission |
I give permission for my child'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 Holiday Club?: |
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Please enter the verification number on the right:*
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* Required Fields |
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