HBC Registration - Kids Form

HBC Registration Form

17th - 21st August 2026
Once you have completed and submitted this form, your child will have a place. If your circumstances change then please message us on 07591148257 as we always have a waiting list.
Child's Name

First NameLast Name
Preferred name (if different from first name)
Birth Date

MonthDayYear
Address

Address

Street Address Line 2

City

Post Code
What school year will your child be starting in September?
Name, address and telephone number of GP
Details of additional needs, medical conditions, allergies etc.
I give permission for any necessary medical treatment to be administered by the nominated first aider.
If I cannot be contacted, I authorise an adult leader to sign, on my behalf, any written form of consent required by the hospital (every attempt will be made to contact you asap).
I allow my child to be photographed (only for the use of video replays within Bethel Church).
I am happy for my child to have their face painted
Parent/guardian name

First NameLast Name
Email address (we’ll use this email for holiday club updates and general information. For emergencies, we will contact you by phone).
example@example.com
Email consent
Contact telephone number: (will be used in emergencies)
Please enter a valid phone number Format: (000) 000-00000.
Signature
Should be Empty:

HBC Registration Form