Holiday Bible Club
Senior section (P7+) - Monday 22nd - Wednesday 24th June 2026
Child's Name
*
First Name
Last Name
DOB
*
-
Day
-
Month
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Post Code
Please indicate medical conditions, special needs, allergies et cetera
*
Name and Address of GP
Name
*
Dr
Name
Address
*
Street Address
Street Address Line 2
City
State / 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 Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: 00000000000.
Relationship to child
Name 2
*
First Name
Last 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
*
Yes
No
I give permission for photographs/video to posted to facebook and instagram
*
Yes
No
I give permission for my child to have juice and snacks
*
Yes
No
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 name
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: 00000000000.
Relationship to child
Date
*
-
Day
-
Month
Year
Date
Submit
Should be Empty: