Histon and Impington Council of Churches
Holiday Club 2017

If you wish to register your child for Holiday Club please fill in and press Register.

First Name of child

Surname of child
School Year   R    1    2    3    4    5    6

First Name of Parent/Guardian

Surname of Parent/Guardian

E-mail Address

Emergency Contact Numbers

    Mobile

    Home

Alternative Emergecy Contact
Name
Number

Who will be responsible for collecting your child?

   *If Mad Hatters please make your own arrangements with them.

If a named person or 'other', who is this?


Names of Friends of child (for group allocation (Max 2))
Please list special needs
Please list medical notes (including allergies)

By Registering in this way:
1. I give permission for my child to attend and take part in the activities of Holiday Club.  In the event of an illness or accident requiring emergency hospital treatment, I authorise the Leaders to sign on my behalf any written form of consent required by the hospital authorities, if the delay required to obtain my signature is considered inadvisable by the doctor or surgeon concerned.
2. I understand that, occasionally, the leaders may photograph or ?lm my child*.  These photographs may be displayed or published. In accordance with Child Protection regulations, names will not be displayed alongside the photographs.  If you would prefer NO photos of your child please tick this box 
3. I understand that my child will be taken care of in accordance with the Child Protection Policy of the churches (details available on request).
4. I understand that Holiday Club ?nishes at 12.30pm and that I am responsible for my child from this time onwards