Captain Ted's Holiday Club Form

Captain Ted's

Old Church Hall

West Ave

Gosforth

Newcastle upon Tyne

NE3 4ES
Ted's Holiday Club Registration Form
Child's details
Full Name*

First NameLast Name
What s/he likes to be called
Date of Birth*

MonthDayYear
Current Age*
School Attended*
First Language*
Parent's details 1:
Title*
Full Name*

First NameLast Name
Home Address*

Street Address

Street Address Line 2

CityCounty

Postal / Zip Code
Does this child normally live at this address?*
Work Address

Street Address

Street Address Line 2

CityCounty

Postal / Zip Code
Mobile Number*

Area CodePhone Number
Work Number
E-mail*
example@example.com
Parent's details 2:
Title
Full Name

First NameLast Name
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does this child normally live at this address?
Work Address

Street Address

Street Address Line 2

CityCounty

Postal / Zip Code
Mobile Number

Area CodePhone Number
Work Number
E-mail
example@example.com
Emergency contact details

(please provide details of two people we can contact if we are unable to get hold of you)
Contact 1
Name*

First NameLast Name
Mobile Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityCounty

Postal / Zip Code
Relationship to child*
Contact 2
Name*

First NameLast Name
Mobile Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityCounty

Postal / Zip Code
Relationship to child*
A password system may be initiated if there is a change to the authorised person collecting your child.
Password if someone else collects your child*
Child's Doctor
Name of Doctor
Address

Street Address

Street Address Line 2

CityCounty

Postal / Zip Code
Phone Number

Area CodePhone Number
About your child
Please detail any additional/special needs your child has: (please provide full details)
Please detail any dietary requirements / food allergies for your child: (please provide full details

Photograph Permission form

The use of photographs is an important developmental tool which is widely used in play and educational settings for recording, sharing and displaying activities that your children have undertaken. At Ted’s Club we take the issue of child protection very seriously and we would never knowingly publish an image of your child without your consent.
As the parent or carer of the child named below, I grant permission for images of my son or daughter to be used for the following purposes: (please tick for consent)
I understand that personal details or names of any child in a photograph will never be given in such a way that would allow them to be individually identified. I understand that this image will NOT be used for anything which may be viewed as negative in tone or that may cause offence, embarrassment or distress for the child or their parent or carer. I understand that there will be no payment for my child’s participation.
Child's Name*

First NameLast Name
Signed*

Powered by Jotform SignClear
Name of parent/carer*

First NameLast Name
Date*

MonthDayYear
Date

ALL ABOUT ME
Insert a photo

Cancelof
This is me aged
The most important people in my life are
My favourite colour is
My favourite food is
My favourite drink is
My favourite books are
My favourite TV shows are
My favourite activities are
I'm afraid of/I really dislike (food, games etc)
When I'm tired I
When I'm scared I
Should be Empty:

Ted's Holiday Club Registration Form

Child's details

Parent's details 1:

Parent's details 2:

Emergency contact details

Contact 1

Contact 2

Child's Doctor

About your child

Photograph Permission form

ALL ABOUT ME