Registration Form
HBC 18th - 22nd August 2025
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 Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
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1965
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1961
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1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Address
*
Address
Street Address Line 2
City
Post Code
What school year will they be moving to in September 2025?
*
Name, address and telephone number of GP
*
Details of additional needs, medical conditions, allergies etc.
Name of child's friend attending HBC
I give permission for any necessary medical treatment to be administered by the nominated first aider.
*
Yes
No
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).
*
Yes
No
I allow my child to be photographed (only for the use of video replays within Bethel Church).
*
Yes
No
I am happy for my child to have their face painted
*
Yes
No
Parent/guardian name
*
First Name
Last Name
Contact telephone number: (will also be used in emergencies)
*
Please enter a valid phone number
Format: (000) 000-00000.
Signature
*
Submit
Should be Empty: