The Mall Presbyterian Church Armagh Holiday Bible Club

The Mall Presbyterian Church Armagh Holiday Bible Club

18th-20th August - 6:30-8:00pm - P1 - P7 (Class going into in September)
Consent Form
Please complete this consent form for each individual child attending our Holiday Bible Club. Anything written on this form will be held in confidence. The leaders need to know these details in order to meet the specific needs of your child.
Child's Details
Child's Full Name

First NameLast Name
Date of Birth

DayMonthYear
Date
Class that your child is going into in September
Address

Street Address

Street Address Line 2

City/TownCounty

Post Code
Name of GP & Surgery
Emergency Contact
Emergency Contact 1
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 00 000 000.
Relation to Child
Emergency Contact 2
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 00 000 000.
Relation to Child
Medical Information
Are there any medical requirement or additional needs relevant to your child, any medication being taken and anything else that would be helpful for the leaders to know about:
If 'yes' please provide details of any medical requirement for your child below.
Are there any allergies or dietary requirements relevant to your child, any medication being taken and anything else that would be helpful for the leaders to know about:
If 'yes' please provide details of any dietary requirement for your child below.
Is there anything else that we should know to ensure the safety and well-being of your child during our Holiday Bible Club?
Consent
Please select below to confirm that you have read and understand the following statements:
Name of Parent/Guardian

First NameLast Name
Date

DayMonthYear
Date
Signature of Parent/Guardian
Should be Empty:

The Mall Presbyterian Church Armagh Holiday Bible Club

Child's Details

Emergency Contact

Medical Information

Consent