XLSHM2026 Stenhousemuir Easter Holiday Club: Child Registration

Stenhousemuir Easter Holiday Club: Child Registration

10am-12.00noon, 13th - 14th April The venue is Tryst Church, Kirk Ave, Stenhousemuir, LarbertKirk Ave, Stenhousemuir, Larbert, FK5 4QB
Young Person's Details
Child's name*

First NameLast Name
Preferred Name*
I would like to register my child for (please tick whole event or the days that your child will attend)*

Monday 13 AprilTuesday 14 April
Sex*

MaleFemale
Date of Birth*

DayMonthYear
Date
Address*

Address Line 1

Address Line 2

Address Line 3Address Line 4

Postcode
School Year (August 2025 - June 2026)*
School attending*
Name of School
Emergency contact name*
Emergency contact phone number*
The child may be collected by*
Please indicate if the child can go home unaccompanied at the end of the day*

YesNo
Medical Details
GP name*
GP telephone number*
Does your child have any dietary requirements (including food allergies)*

yesno
if yes, please indicate dietary requirements (including food allergies)
Any other known allergies*

yesno
if yes, please indicate allergies
Any known health issues*

yesno
If yes, please indicate health issues
Any known Additional Support Needs*

yesno
If yes, please indicate Additional Support Needs
Parental Consent
I confirm that the details are correct and complete to the best of my knowledge. In the event of illness, or accident, I give permission for any necessary medical treatment to be given by the nomainted first-aider. In an emergency and if I can't be contacted, I am willing for my child to receive hospital treatment if necessary. I understand that every effort will be made to contact me as soon as possible.
Parent/Guardian Details
Parent/guardian name*

Mr/Mrs etcFirst NameLast Name
Parent/guardian email address*
example@example.com
Parent/guardian contact numbers*

Main contactAlternate contact
My child is under 16 and I give consent for their photo/video to be used for publicity purposes*

yesno
I am happy to receive information about future events which may suit my child*

yesno
SU Scotland and our partnering church(e)s are jointly responsible for this data. SU Scotland promises to look after your data in accordance with the General Data Protection Regulation. For more information, visit suscotland.org.uk/privacy. For more information on the partnering church(es) privacy policy, please contact the church.

SU Scotland is registered as a charity (no. SC011222) and as a company limited by guarantee (no. SC54297)
Please verify that you are human*
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Stenhousemuir Easter Holiday Club: Child Registration

Young Person's Details

Medical Details

Parent/Guardian Details