Southern Cross Holiday Club

Page 1

HOLIDAY CLUB Registration Form
(please use a separate form for each child)

Child’s full Name

 Sex: M/F

Date of Birth

School

Please register my child for Summer Holiday Club 2010

Parent’s/guardians signature

Legal Guardian

Parent’s/Guardian full name

Address

Postal Code

Home phone number

Mobile number

Works phone number

Other emergency number

I give permission for my child’s and my details to be entered on the church database Yes/No

Page 2

Holiday Club Consent Form (please use a separate form for each child)

Child’s full name

Date of Birth

Address

Emergency contact name

Phone number

GP’s Name

GP’s phone number

Any Known allergies or condition.

I confirm that the above details are complete and correct to the best of
my knowledge.

In the unlikely event of illness or accident, I give permission for any appropriate
first aid to be given by the nominated first-aider. In an emergency, and if
I cannot be contacted, I am willing for my child to be given hospital treatment,
including anaesthetic if necessary. I understand that every effort will be made
to contact me as soon as possible.

Signature of Parent/guardian: