Online Registration Form › Knaresborough United Reformed Church Online Registration Form, LANDLUBBERS HOLIDAY CLUB

Monday 31 July - Friday 4 August 10.00am -12.00 noon

for all primary school aged children

(including those who have completed Foundation Stage)




Child's Full Name:
Child known as? (eg. Thomas/Tom)
Gender: Male
Female
Date of Birth: (dd/mm/yyyy)
School:
Parent/Guardian's Full Name:
Address:
Email Address: (used only for acknowledgement)
Your Telephone Number:
Emergency Contact Name and Number:
GP's Name and Number
Any Know Allergies or Conditions:
In the unlikely event of illness or accident, I give permission for any necessary medical treatment to be given to by the nominated first-aider. In an emergency and if I cannot be contacted I am willing for my child to receive hospital treatment, including anaesthetic, if necessary. I understand that every effort will be made to contact me as soon as possible; Yes
No
I give permission for my child's photograph to be taken and used on the URC website/magazine/local press: Yes
No
I confirm the above details are complete and correct to the best of my knowledge: Yes
No
We may occasionally contact you with details of future childrens events at Knaresborough United Reformed Church? Yes
No