Superhero School Registration Form    


Tuesday 27th August 2019 to Friday 30th August 2019

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 

Post Code:

Phone Number: 
School Year (Academic year 2018/2019): 

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

Please give details of anything we need to be aware of for
Medical conditions (include any medication):  
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 27th August and the 30th August 2019.

Payment can be made by bank transfer to:

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

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

I consent to the information I have given in this form being used by Cheam Baptist Church for managing my child’s involvement with Superhero School.
Any personal data provided to Cheam Baptist Church in this form will be treated in accordance with the Privacy Notice on our church website.
I would like to be informed by email of next year's holiday club run by Cheam Baptist Church.