Welcome to the form for children!  Filled this out before?  Go here!

Didn't want this one?  The form for young helpers is here, and the form for adult helpers is here.

Want any of the details of holiday club again?  Head back here!

Details of Child
Name *
Date of Birth *
Date of Birth
Watch out! Our website builder insists on month-day-year...
Days Attending *
Medical Details of Child
Does s/he have any medical conditions or recurrent illness (e.g. asthma, hay fever, migraine, fits/faints, disability, etc.)? *
Is s/he taking any medicine or undergoing any treatment that needs to be continued during the event? *
Is s/he known to be allergic or sensitive to anything (e.g. penicillin, aspirin, other medicines, food, etc.)? *
Does s/he have any specific dietary requirements? *
Is there any other important medical information that you feel you should disclose? *
Emergency Contacts
Name *
Name *
Additional Permissions
Do you give permission for photos to be taken of your child during event activities? *
Do you give permission for these photos to be used for publicity purposes? *
Do you give permission for the above details to be held after the event? *
[This means you don't have to fill this form out again!]
May we use these details to contact you about other, similar events in future? *
[i.e. future holiday clubs]
Parental Consent
I give consent for the child named above to participate in the above mentioned event and I acknowledge the need for acceptable responsible behaviour on her/his part. I understand that while involved s/he will be under the control and care of the group leader and/or other adults approved by Bury Parish Church and that, while those in charge will take all reasonable care of the children, they cannot necessarily be held responsible for any loss, damage or injury suffered by her/him during, or as a result of, the activity. In an emergency and/or if I am not contactable, I am willing for her/him to receive necessary hospital or dental treatment including an anaesthetic. *

If you have any questions, you can contact someone using the list of contacts available here.