Holiday Club Application Form 2025

Rise and Shine Application Form

28th, 29th and 30th October 2025
Rise and Shine will be running from 9am to 3pm on the 28th, 29th and 30th of October 2025. There is a £30 cost per child for the Holiday Club. You will need to provide your child with lunch as we do not have the facilities on site to provide lunch. We will be operating as a nut free zone for the Holiday Club so please avoid sending items containing nuts in your childs lunch box.

We have limited space for Rise and Shine Holiday Club and therefore we will be operating a first come first served policy when it comes to applications. Once you have filled in this form you will receive an email from Tim Ball the Children's and Youth Minister which will either confirm your application and provide you with information on how to pay the £30 cost or will inform you that your child has been placed on the waiting list.

Please fill out this form seperately for each child who you would like to attend.

If the cost is an issue please do not hesitate to contact Tim as we don't ever want that to be a barrier to children joining us.

Rise and Shine Holiday Club is designed for Children in Reception to Year 6 and so we will only be accepting applications for children in that age range.

All information in this form will be stored and used in line with St Mark's Woodthorpe's Data Protection Policy which can be found here: https://stmarksonline.co.uk/data-protection/

If you have any questions please contact Tim Ball at cym@stmarksonline.co.uk
I have read and understand the above statements.*

Yes
Child's Information
Child's Name*

First NameLast Name
Child's Date of Birth*

DayMonthYear
Date
Child's School and Year*
As of September 2025.
Child's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do they have any medical, dietary, or other needs that we need to be aware of.*
Please type N/A if there are no additional needs. Please include any medication that the young person may need to take while at St Mark's groups and activities.
Parent/Guardian's Information

This information will also be used as the primary emergency contact.
Name*

First NameLast Name
Relationship to Young Person*
Email*
example@example.com
Phone Number*
Emergency Contact 2

In the event of being unable to contact the above parent/guardian we will contact this person.
Name*

First NameLast Name
Relationship to Young Person*
Phone Number*
Doctor's Information

Please provide the information of the Young Person's GP.
Doctor/Surgery Name*
Doctor/Surgery Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Doctor/Surgery Phone Number*
Consent
I give permission for the young person to attend Rise and Shine Holiday Club at St Mark's Woodthorpe on the 28th, 29th and 30th October 2025.*

Agree
In the event of a medical incident or emergency I give permission for the leaders of St Mark's Woodthorpe groups/activities to provide First Aid and seek further medical assistance if appropriate.*

Agree
We may take photos/videos of our activities and groups to use in publicity in church, on the church website, on social media and in the community. Please indicate where you are happy for us to use photos/videos of the child.*

In churchOn the church websiteOn social mediaIn the communityI do not give consent for the young person's photo/video to be used for this purpose.
Signature*
Date*

DayMonthYear
Date
Should be Empty:

Rise and Shine Application Form

Child's Information

Parent/Guardian's Information

Emergency Contact 2

Doctor's Information

Consent