Easter Adventure Holiday Club

Easter Adventure Holiday Club

Newton Wallacetown Church/RoomSixty 60 Main Street, Ayr KA8 8EF
Saturday, 5th April 2025

2pm-4pm FREE (food for whole family at 4pm)
Young Person's Details
Name of Child*

First NameLast Name
Preferred name
Sex*

MaleFemale
Date of Birth*

DayMonthYear
Date
Address*

Address line 1

Address line 2

Address line 3Address line 4

Postal Code
School Year (August 2024-June 2025) *
School Attending*
Emergency Contact Name*
Relationship to child*
Emergency Contact Phone Number*
Please indicate if the child has permission to go home unaccompanied.*

YesNo
Medical Details
GP Name*
GP Phone Number*
Does your child have any dietary requirements?(including food allergies)*

YesNo
If yes, please give details:
Any other known allergies?*

YesNo
If yes, please give details:
Any other known health issues?*

YesNo
If yes, please give details:
Any known additional support needs?*

YesNo
If yes, please give details:
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 nominated 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*

First NameLast Name
Parent/Guardian Contact Number*
Parent/Guardian Email Address
example@example.com
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
Signature*

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Easter Adventure Holiday Club

Saturday, 5th April 2025

Young Person's Details

Medical Details

Parent/Guardian Details