Summer Holiday Club 2018

Registration and Consent Form

Highgate School, Sileby

10am to 12:30pm - July 30^th 2018 to 1^st August 2019

Click here for full details of Summer Holiday Club

Please complete the form below if you would like your child to attend Egyptian Adventure holiday club run by the United Benefice of Sileby, Cossington & Seagrave. If you have more than on child who would like to attend you will need to complete one form for each child.

Child's Full Name (required)

Current school year (required)

Date of Birth (required)

Name of school attended (required)

Parent/Guardian name (required)

Relationship to Child (required)

Parent/Guardian Email (required)

Postal Address (required)

Parent/Guardian phone number - where we can contact you in case of emergency during holiday club (required)

GP’s name, address and phone number (required)

Any known allergies, medical conditions, current medication * (see note over the page) or special needs that we need to be aware of: (required)

If medication is required during this or future events, then please ensure it is brought to the event with written instructions for administration.

Please name adult(s) who will be collecting child from event (required)

Name and contact number of another adult – will be used only if we cannot contact you in case of emergency (required)

I give my permission for my child to participate in the Egyptian Adventure Holiday Club and any other church-related activities I apply for during 2018/2019 (required)

In the unlikely event of illness or accident I give permission for any necessary medical treatment to be given by the nominated first-aider. (required)

In an emergency, I give permission 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. (required)

I give permission for my child’s photograph to be taken and used (without names), if appropriate. (required)

I give permission for you to retain this data for the purpose of informing me about future events. (required)

In submitting this form you are agreeing to the following:

I understand that whilst every care and attention will be given to my child, the United Benefice of Sileby, Cossington and Seagrave and the leaders and helpers of the event cannot accept any responsibility for personal accident or loss/ damage to personal property.

The United Benefice of Sileby, Cossington & Seagrave takes the security of your data very seriously. Please read our Data Privacy Policy Notice for further details.