Going for Gold Registration

Outlook Club Registration

Bethel Church, Spon End, Coventry CV1 3HB.
Outlook is a free, fun, fortnightly children's club for ages 5 and up.

We will be having games, Bible stories, crafts, music and a tuck shop!
Childs Name*

First NameMiddle NameLast Name
Date of Birth*

DayMonthYear
Gender
Address*

Street Address

Street Address Line 2

CityState / Province

Post Code
Parent/Carer Name*

First NameLast Name
Parent/Carer Email*
example@example.com
Parent/Carer Mobile Number*
Emergency Contact (different to above if possible)*

First NameLast Name
Emergency Contact Mobile Number*
Please give details of any dietary requirements*
If none, please type 'none'
Please give details of any additional support needs*
If none, please type 'none'
Should be Empty:

Outlook Club Registration