2023 Activity Days Booking Form

Child's Name*

First Last

Your E-mail Addres*

(required as main form of contact regarding activity days)

Age on 24th July 2023*

Current School Year*

Gender

Male
Female

Is their birthday during the week of the Activity Days?

Address*

Street Address City ZIP / Postal Code

Phone Number*

Emergency Contact*

(name, phone no. and address if different to home)*

Are there any friends/relatives with whom your child would like to be placed in a group? (Please provide their names and we will do our best to put them together?

Please detail anything about your child which will help us (allergies, health problems, educational or special needs):

Have you previously attended St John's Church activity days?

Permission*

I give permission for my child to be taken on supervised short walks around Muxton or to the park next door (click the box for Yes)
I give permission for my child to be given first aid if required
I give permission for photographs of the activity days which may include my child to be used by the church, including on the church website (click the box for Yes)*
I will be able to accompany my child to a short service at the end of the day on Thursday 27th July to show you what we have been up to. (click the box for Yes)

Name of Parent/Guardian*

First Last