Registration Form    

Dino-Snores Banner 

Tuesday 29th August 2017 to Friday 1st September 2017

Cost of the holiday club is £20 per child and then £15 for each additional sibling from the same family

Please submit 1 form per child


Child's Surname:                                            Child's Forename: 
Gender:                                                                 Date of Birth: Day  Month  Year 
 

Address:
 
 
Town:
Post Code:

Phone Number: 
School Year (Academic year 2016/2017): 
School Attended: 
Would your child like to be in the same group as a friend?        If yes, please state their name: 
Parent's Email Address: 

Emergency Contact Details:

  Name of Contact Relationship to Child Phone Number
1
2
3


Please give details of anything we need to be aware of for
Medical conditions (include any medication):  
Allergies:
Dietary requirements: 


I consent for medical treatment or first aid arising out of illness or accident. 
I give permission for photographs and video of my child to be used in presentations of the holiday club, displays in the church buildings, or on the church website. 

By submitting this form I give permission for my child to take part in holiday club activities at Cheam Baptist Church between the 29th August and the 1st September 2017.


Payment can be made by bank transfer to:

Barclays Bank
Sort Code: 20-84-17
Account number: 70246182

For a payment reference please use: HBC plus the Surname and Initial of the child. If you are paying for more than one child, please provide their name(s) and surname(s). 

Please make cheques payable to Cheam Baptist Church and write the name(s) of the child(ren) on the back of the cheque and post to:

Dino-Snores Holiday Bible Club
Cheam Baptist Church
4 Park Road
Cheam, SM3 8QB.