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Registration form

By registering online, it is necessary for you to accompany your child to 1 on the first day, Monday 2nd August, in order to sign the consent section of the registration form.

Child's Full Name:
Gender: Male
Female

Date of Birth: (dd/mm/yyyy)
School:
Parent/Guardian's Full Name:
Address:
Email Address: (used only for acknowledgement)
Your Telephone Number:
Emergency Contact Name and Number:
GP's Name and Number
Any Know Allergies or Conditions:
In the unlikely event of illness or accident, I give permissiosn for any necessary medical treatment to be given to by the nominated first-aider. In an emergency and if I cannot be contacted I am willing for my child to receive hospital treatment, including anaesthetic, if necessary. I understand that every effort will be made to contact me as soon as possible; Yes
No
I give permission for my child's photograph to be taken and used on the URC website/magazine/local press: Yes
No
I confirm the above details are complete and correct to the best of the knowledge: Yes
No
How did you hear about the Holiday Club: School
Church
Word of Mouth
Website
Poster
Local Press
Other

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