Holiday Club Application Form

Banner Cross Methodist Church Holiday Club 2011

APPLICATION FORM

Please register my child for a place on Pyramid Rock

At Banner Cross Methodist Church 1st – 5th August 2011

(please complete a separate form for each child)

Child's full name :*
Sex:*	Male Female
Date of birth :*
School attended:*
Days Attending:*	Monday Tuesday Wednesday Thursday Friday
Parent's/Guardian's full name :
Address :*
Phone number :*
I give permission for my child's and my details to be entered on the church database:*	Yes No
I give permission for photographs to be taken for church use:*	Yes No
I give permission for any emergency dental, medical, or surgical treatment, including anaesthetic, as considered necessary by the medical authorities present:*	Yes No
Please enter the verification number on the right:*
* Required Fields