Child's Surname: Child's Forename:
Gender: MaleFemale Date of Birth: Day 12345678910111213141516171819202122232425262728293031 Month JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Year 20052006200720082009201020112012201320142015
School Year (Academic year 2018/2019): ReceptionYear 1Year 2Year 3Year 4Year 5Year 6
Would your child like to be in the same group as a friend? YesNo
If yes, please state their name:
Parent's Email Address:
Emergency Contact Details:
Please give details of anything we need to be aware of for
Medical conditions (include any medication):
I consent for medical treatment or first aid arising out of illness or accident. YesNo
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. YesNo
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
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).
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.YesNo
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.YesNo