1st Child
School
Name
Date of Birth
Home Phone
Mobile Phone
Address
School Year
Any medical / dietary info
2nd Child
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
With support from North East
Community
Improvement
Partnership