Holiday Bible Club 2026 - Junior section P1

Child's Name

First NameLast Name
DOB

DayMonthYear
Date
Current school class
Address

Street Address

Street Address Line 2

CityState / Province

Post Code
Please indicate medical conditions, special needs, allergies et cetera
Name and Address of GP
Name

DrName
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: 00000000000.
Emergency contact names and phone numbers (if parent/carer below not available)
Name 1

First NameLast Name
Phone Number
Please enter a valid phone number.Format: 00000000000.
Relationship to child
Name 2

First NameLast Name
Phone Number
Please enter a valid phone number.Format: 00000000000.
Relationship to child
Permissions
I give permission for photographs/video to be taken within the club for use at the club
I give permission for photographs/video to posted to facebook and instagram
I give permission for my child to have juice and snacks
I confirm that the above details are complete and correct to the best of my knowledge.
In the event of illness or accident, having parental responsibility for the above named child, I give permission for first aid to be administered where considered necessary by a first aider, if available, or medical treatment to be administered by a suitably qualified medical practitioner.
In the event of a medical emergency, leaders will endeavour to contact you as soon as possible using the contact telephone numbers given.
I will inform the leaders of any important changes to my child’s health, medication or needs and also of any changes to our address or to any of the phone numbers given above.
Parent/Guardian

First NameLast Name
Phone Number
Please enter a valid phone number.Format: 00000000000.
Relationship to child
Date

DayMonthYear
Date
Should be Empty:

Name and Address of GP

Emergency contact names and phone numbers (if parent/carer below not available)

Permissions

I confirm that the above details are complete and correct to the best of my knowledge.

In the event of illness or accident, having parental responsibility for the above named child, I give permission for first aid to be administered where considered necessary by a first aider, if available, or medical treatment to be administered by a suitably qualified medical practitioner.

In the event of a medical emergency, leaders will endeavour to contact you as soon as possible using the contact telephone numbers given.

I will inform the leaders of any important changes to my child’s health, medication or needs and also of any changes to our address or to any of the phone numbers given above.