Mossley Hill Holiday Club Registration

Mossley Hill Church

Holiday Club 2025

Monday 11th to Friday 15th August 1.00pm - 4.00pm

REGISTRATION FORM

To be Completed by a Parent or Guardian.

To provide for your child's needs and to meet the requirements of the Local Authority we require the following information at registration. Once we receive your registration we will normally contact you withing 4 days to confirm your child's place.

Up to three children may be entered on this form as a single submission. The form is divided into three sections:

1. Parent/Guardian Details [This must be completed before continuing].

2. Child Details

3. Permissions and Registration

The information recieved will be stored on a church database. It will be used for Holiday Club purposes and may be retained for 12 months to notify you of next years holiday club and any associated events organised by Mossley Hill Parish Church. It will not be used for any other purposes or provided to any other bodies.

If there are any changes to the information after registration please let us know by email. When you first bring your child to Holiday Club you will be asked to sign a copy of the form.

Thank you.

If you have any Queries please email

holidayclub@mossleyhillchurch.org.uk

1. Parent or Guardian
Parent/Guardian's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Post Code
Phone Number*
Alternative Phone Number during Holiday Club
Email*

Confirmation Emailexample@example.com
How Many Children are you including on this form*

OneTwoThree

Permissions
3. Permissions
Photography and Video Recording

In order to control the publication of images, Photos and Video will only be taken by people specifically authorised to take photographs or video by the church's safe guarding officer. These people will wear an authorised badge. No other photography or video recording will be allowed.

Authorised photographs and video may be displayed at events organised by Mossley Hill Parish Church in printed from or by media projection. They may also be published on the Mossley Hill Church website and official facebook page. The Church will remove any images on request from relevant people. Published photographs may also be used by the Liverpool South Deanery and Liverpool Diocese for general publicity.
Do you give permission for your child to be included in photos and videos as described above?*

YesNo
I give permission for the following children to be included in photos and videos as described above.*
Please state "All" or name each child that may be included
MEDICAL ASSISTANCE

In the unlikely event of illness or accident, I give permission for any necessary mediacl treatment to be administered by the nominated first aider, or by suitably qualified medical practitioners.

Should my child require emergency hospital treatment, I authorise an adult leader to sign on my behalf any written form of consent required by the hospital if I cannot be contacted. I understand that every effort will be made to contact me as soon as possible.
Do you authorise medical assistance for your child/children as descibed above?*

YesNo
DECLARATION
I confirm the details given on this form are correct to the best of my knowledge, and request that my child/children are registered for Team Builders Holiday Club.
REGISTRATION

Thank you for completing this registration form.

If you have any queries please email holidayclub@mossleyhillchurch.org.uk
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