For a guaranteed place please return completed form by July 10th 2017 to

Batheaston Vicarage. 98, High Street. Northend. Batheaston. Bath.

Child’s full name

Date of birth _ _ / _ _ / _ _ _ _ Gender M / F (Please circle)

Full name of parent/guardian

Mobile number

Address

E-mail address

Any allergies/ dietary needs / medications / special education / behavioral needs / anything else we should be made aware of

Alternative name and contact number

Relationship to child

(NB this person will only be contacted if we are unable to reach you)

How did you hear about the holiday club?

Please tick if you would like a T-shirt for your child to wear at a cost of £10

Sizes available – S /M /L (Please circle)

Parent/guardian’s signature

(Please read below points before signing)

Tick here if you object to 1 & 5

By signing to the adjacent page you are agreeing to five things

1)  Photos and videos may be taken of your child and used in St John’s Church displays – this includes websites and social media

2)  In the event of accidents or injuries a qualified first aider will give appropriate first aid. In an emergency and you cannot be contacted you are willing for your child to receive hospital treatment including anesthetic if required. You understand that every effort will be made to contact you.

3)  Christian teaching is the main theme for this event and your child will be given the opportunity to respond to this.

4)  You are responsible fro registering, dropping off and collecting your child

5)  You are happy for us to keep your details to contact you about future events

Snacks will be provided so please state any allergies or dietary requirements on the adjacent page

Holiday Club information

24th – 27th July 2017

At St John the Baptist. Northend. Batheaston. BA1 7EF

BBQ 28th July 2017

At Wayfield North. Solsbury Lane. Batheaston. Bath. BA1 7HB

Parents and Guardians come along and see what your children have been up to. (£2 per person)

Questions??

Contact Serena Stanton

07866 525277

1