1st Child

School

Name

Date of Birth

Home Phone

Mobile Phone

Address

School Year

Any medical / dietary info

2nd Child

School

Name

Date of Birth

School Year

Any medical / dietary info

3rd Child

Email address

Photo

By leaving this box ticked you are giving permission for the children below to have their photo taken. These shots may be used on CBC websites, but no names will be published online. Please clear the box if you don’t want photos to be taken

Parent's Name

By leaving this box ticked you are giving permission for the details of you and your child to be kept on the Church database. This will only be used for this Holiday Club and to tell you about future clubs

Database

School

Name

Date of Birth

School Year

Any medical / dietary info