Razzamatazz Robots Holiday Club Registration/Consent Form (Online)

Please use a separate form for each child

Venue:  Holy Trinity Church and Hall, Chesterton & Vicarage Garden

£2.50 each per session per child, payable on the day 

Child's Full Name :*
Date of Birth:*
Address:*
School Year Just Completed:*	under 5 R Yr1 Yr2 Yr3 Yr4 Yr5 Yr6
Phone number:*
Email:*
Contact in case of emergency:*
Special needs including allergies and medication:*
I hereby give permission for my child to take part in activities at Holy Trinity Church and Hall, Chesterton and Vicarage Garden and my consent for medical treatment or first aid arising out of illness or accident on the following afternoons:*	Wednesday 24th July Wednesday 31st July Wednesday 7th August Wednesday 14th August Wednesday 21st August
I give permission for my child's photograph to be taken during the club. (The photographs will be used for church purposes only, including church magazines and press release):*	Yes No
I give permission for my details to be entered on the church database for purposes of contact:*	Yes No
Signature of Parent/Guardian (Full Name):*
Date :*
Please enter the verification number on the right:*
* Required Fields