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Registration and Consent Form

St George's, Bickley in partnership with

The Annunciation, Chislehurst


Easter Holiday Club

For children in Reception to Year 6

9.45am-12.30pm each day

Wednesday 11 and Thursday 12 April

(including a picnic-style lunch with families on the Thursday)

All at The Church of the Annunciation, High Street, Chislehurst

Closing date for applications Wednesday 4 April!

Groupings for some activities will be by school year. Whilst no guarantee can be made, we will make every effort to enable friends to be together.

Full Name of Child:*
Current Year Group:*
Date of Birth (dd/mm/yyyy):*
Name of Friend Attending* :
Family Home Address:*
Post Code:*
Home Telephone Number:*
Mobile No:*
Alternative Contact Telephone Number:
E-mail Address:*
Name of Person Collecting Your Child:*
GP's Name:*
Telephone Number:*
Details of any known conditions/allergies/phobias/dietary requirements and any activity the child should not be allowed to participate in:
Is any medication required during holiday club? If so, please give exact details, remembering to name-label and, where appropriate, hand in medication on arrival each day:
I give permission for any necessary medical treatment by the nominated First Aider, AND hospital treatment, including an anaesthetic, as appropriate:*
I give permission for my child to be photographed during Holiday Club week. I understand these photos/images may be used by the church for display or promotional purposes only, but no child will be identified by name:*
I confirm that these details are correct to the best of my knowledge: Signed:*
Please Tick:*
Please enter the verification number on the right:*
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* Required Fields

Holiday Club
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