Child 2012

Please fill out the form separately for each child you wish to register.

Your name *
Parent/guardian
Your email address *
So we can contact you with up to date information
Child name *
Please enter first name and surname
Child postal address *
Postcode *
Child telephone number *
Child date of birth *
DD/MM/YYYY
Child school attended on May 1st 2012 *
Child year group on May 1st 2012 *
Children your child would like to be in a small group with if possible
Small groups are arranged by school year and there is no guarantee we will be able to put them with the children you have asked for but we will try our best.
Emergency contact number *
GPs name *
GPs phone number *
Please list details of any known medication, conditions or allergies eg allergy to plasters *
Please enter NIL if none known
Please list details of any learning/behavioural difficulties and ideas on how best to manage them *
Please enter NIL if none known
Permission for necessary medical treatment * Permission granted Permission denied
In the unlikely event of illness or accident, I give permission for any necessary medical treatment to be given by a nominated first aider. In an emergency and if I am not contactable, I am willing for my child to receive hospital treatment, including anaesthetic. I understand that every effort will be made to contact me as soon as possible.
Permission for photos/videos to be taken * Permission granted Permission denied
Photographs and videos will be taken for the purpose on informing the churches and potential funders about the work of holiday club, advertising future clubs and shown on the holiday club website. I give permission for my child to be included in the photographs and videos.
Any other comments/requests

Linlithgow Churches Holiday Club