Holiday Club booking form

Guardians of Ancora Holiday Club 2019

Places will be allocated on a first come, first served basis.

We will contact you only if we are unable to give your child a place.

For further information, recheck the details here or contact Abi by email.

Organised by the churches of St Andrew’s and Christ Church Eaton

St Andrew's Charity Number: 1130712

Christ Church's Charity Number: 1130553

 

 

                                                                                                             


Full name(s) of child(ren):*
Date(s) of birth:*
Address:
Telephone number:
Email:
School(s):*
Any known allergies or conditions :
We try to keep school year groups together but it is not always possible. If there is a friend your child would like to be with please tell us:
Emergency contact name:*
Emergency contact telephone number:*
GP's name:*
GP's telephone number:*
I give permission for the information from this form being submitted through the website and being entered on the church database (if not please complete and return a paper form and do not book online):*
Yes
I give permission for St Andrew’s and Christ Church to email me about future events for children and families.:*
Yes
No
I give permission for my child(ren)’s photograph to be taken during the club (the photographs will be used to create a display in church or on the website or in press releases for a short period after this event.):*
Yes
No
In the unlikely event of illness or accident I give permission for any appropriate first aid treatment to be given.:*
Yes
No
In an emergency, and if I cannot be contacted, I give consent for my child(ren) to receive treatment by a GP and/or hospital, including treatment under general anaesthetic. I understand that every effort will be made to contact me as soon as possible:*
Yes
No
I confirm that the above details are correct to the best of my knowledge.:*
Yes
Parent's/Guardian's full name:*
Parent/Guardian's Address if different from above:
Parent's/Guardian's Telephone number if different from above:
Date:*
Payment method:*
Cheque
BACS
Please enter the verification number on the right:*
nine four six two two
* Required Fields