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Holiday Club Registration
Please use the form below to register your child (one form per child)


Summer fun for 5-11 year olds (Reception - year 6)
Child's Details
Child's Name *
Date of birth *
Age (5-11)*
Will be attending * Tue   Wed   Thu
(Please tick all relevant days)
Child's Address
(in case we need to get them home in an emergency)
Address (No and street) *
Address (Town)
Address (County)
Post Code *
Telephone Numbers (For emergency use) - Parent/Carer
Name *
Home *
Mobile *
Telephone Numbers (For emergency use) - Alternative Contact
Medical Conditions or Alegies
Please give details of any of the named child’s medical conditions (eg. Allergies, asthma, epilepsy, diabetes, dietary needs) or disability that may affect this activity.
Medical Conditions or Alegies
   I give my consent for any medical treatment that may be necessary in the event of an accident or emergency.
Collecting your child from holiday club (please note)

A Child Collection Slip will be given to you when you leave your child with us. For your child’s protection it must be produced when you or someone else comes to collect them. We cannot allow them to leave with anyone else without your permission.

Your Data (GDPR)
This consent form will be kept securely by the responsible Church Worker on the activity. Your details will not be used for any other purpose or passed to any other organisations except in the case of an emergency (e.g. passed on to hospital staff)
Acknowledgement *  I have read the notes above and I give my permission for the above named child to take part in this activity.
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H O L I D A Y   C L U B

School Years: Reception - Year 6
School Years = the year that has just been completed.

Get set for BIG fun
this summer with...

Join us on a creative adventure as we crank up the Mega Machine which makes things BIGGER! But can anything be as big as God’s love?

Tue 24th – Thu 26th July 2018
2.30pm – 4.30pm

Hayes Village Hall

Fun packed afternoons including drama, music,
games, crafts, DVD and lots of fun.

£2.00 per day
Or £5.00 if you attend all three days

Please complete the registration form on
this page to register your child.
Places are limited so sign up TODAY.