Registration Form
Pyramid Rock Holiday Club

Monday 8th August to Friday 12th August 2022
10am–12.15pm each day
PLEASE NOTE: WE ARE NOW FULL UP.
IF YOU REGISTER YOUR CHILD NOW HE/SHE WILL BE PUT ON A WAITING LIST.

PAYMENT WILL ONLY BE TAKEN IF YOUR CHILD GAINS A PLACE.

Cost: £5 per day
(indicate below any days child NOT attending)

You can register one child using this form.
Fields marked with a red asterisk must be completed.

Child's Name:*
Gender:	M F
Date of birth:*
Primary Class in August 2022:*
Any days child NOT attending Holiday Club?:	Monday Tuesday Wednesday Thursday Friday
Known allergies or conditions (or reply NONE):*
Parent/Guardian's Name and Address:*
Landline or Mobile Number:*
Email address:*
Emergency Contact (Name and Telephone Number):*
Child's GP's Name, Address and Telephone Number:*
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?:	In Greenbank weekly e-newsletter In Greenbank Connections newsletter Poster in Church premises or elsewhere From School newsletter From an organisation that meets at Greenbank By word of mouth Other
Please enter the verification number on the right:*
* Required Fields