Aquatic Adventures Registration Form    

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Tuesday 28th August 2018 to Friday 31st August 2018

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 2017/2018): 

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 28th August and the 31st August 2018.

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 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 Aquatic Adventures.