SummerHoliday Club
REGISTRATION FORM
Wed 25th July – Sat 28th July2018
(9.30-12.00)and Sun 29thJulyat 10am (with parents/guardians)
Please return ASAP with £5 per child (Max £10 per family)
Full name of child: Sex: M / F
Main information
Address:
Postcode:
Date of birth: DD / MM /YY School:School Year Just Completed R 1 2 3 4 5
Parent/Guardians name(s):
Home number:Mobile number:
Main contact email address:
Does your child have a friend coming (of same age) who they would like to be in the same group as? Please give full name…
Pickup
Who will normally collect your child?
If your child will be leaving with somebody else please leave a message at the registration desk on arrival or in an emergency phone the church during the holiday club on 01243 782582.
Please state if they are allowed to make their own way home:
Declaration
- I give consent for my child/young person to take part in the events run by Chichester Baptist Church.
- I consider my son/daughter to be medically fit to participate in general group activities.
- In an emergency and/or if I cannot be contacted, I am willing for my child/young person to receive necessary hospital or dental treatment including an anaesthetic.
NB If this is not acceptable please contact our Children’s Ministry Leader. Thank you.
At times photographs taken at our children’s and young people’s events may appear in church information material, our church website or the local press. No names of children will be printed. IF YOU DO NOT WISH YOUR CHILD’S PHOTOGRAPH TO APPEAR YOU MUST INFORM US IN WRITING AND SEND THIS TO: Victoria Jones, Chichester Baptist Church, Sherborne Road, Chichester, PO19 3AW.
I would like to receive emails about relevant CBC events throughout the year Yes No
PLEASE NOTE
1) By signing this form you have agreed to ensure your child is aware of the importance of
responding to reasonable requests and instructions of those leading the group. Your child should
understand that this is for their safety and that of the entire group. It is also to enable the
smooth running of the activities so that everyone can enjoy participating.
2) By signing this form you are also agreeing to collect your child from the church or excursion if
their actions are compromising safety or smooth running of events.
The information on this form will be stored on a secure database and used for Holiday Club purposes only.
Signed Date: DD / MM / YY
(parent or adult with parental responsibility)
Now turn over to 2nd page
Additional Emergency Contact Details
The person to contact in case of emergency if named parent/guardian is not available:
Name:
Address:
Postcode:
Home telephone number:
Mobile telephone number:
Relationship to child if any:
Medical Details
(If more space is requiredplease continue on a separate sheet, sign and attach. Any part left blank will be considered N/A)
Please give details of any allergies, medical conditions or disabilities that your child has:
Will your child be bringing any medicines to the holiday club? Please give details
We will provide children with a snack which will normally be a drink of squash/water and a biscuit. If this will not be appropriate for your child because of food allergies please provide your child with a safe (but similar) alternative and tick this box
Senior Minister: Rev Ken Benjamin Minister: Rev Ellen Wild
Church Ministry Leader:Roger Hubert Youth Ministry Leader: Andy Morgan
Children’s Ministry Leader: Victoria Jones
Chichester BaptistChurch
124 Sherborne Road, Chichester, West Sussex, PO19 3AW
Tel: 01243 782582 Email:
Chichester Baptist Church is a registered Charity, Number 1127703
Have you completed the 1st page?