Jelly Bean registration

Jelly Beans

Baby/Toddler Club: Craigmailen Church, Bo'ness
Please fill out the form and join us on a Friday between 10am and 11:30am during term time. We look forward to seeing you.
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Contact number
E-mail*
CHILD INFORMATION:
Child Name*

First NameLast Name
Birth Date*

MonthDayYear
Any allergies we should be aware of?*
Child 2

(If applicable)
Child Name

First NameLast Name
Birth Date

MonthDayYear
Any allergies we should be aware of?
Child 3

(If applicable)
Child Name

First NameLast Name
Birth Date

MonthDayYear
Any allergies we should be aware of?
Craigmailen Church confirm that all data will be stored securely and used only in relation to Jelly Beans Baby and toddler club

You can ask for you and your child's registration to be removed at any time.
Should be Empty:

Jelly Beans