Duncan Road Church

Child's Information

Full Name

Gender Male Female

Address

Post Code

Phone

Date of Birth

School and Year

Dietary or
Medical Needs

Parent/Guardian Information

Title and Surname

Relationship to Child

Address
(If different to above)

Post Code

Phone

Email

Emergency Contact #

Please fill out all the above fields.

I am a Parent/Guardian and I have read the information contained in the brochure or on the relevant section of this website, and in the Privacy Statement, and I give my permission for my child to attend the Holiday Club. The person applying is fit to attend the event and is able to participate in all activities (unless otherwise indicated in my reply to your follow-up email). She/He will abide by event rules or I am willing to collect my child from the event and take him/her back home. If required, I agree that emergency medical treatment may be given as appropriate.

Over the years we have posted photos and videos of the holiday club online to share memories and give others a glimpse of what happens. We also sometimes use these images to help publicise events. Are you and your child happy for photographs and videos to be taken of your child during the holiday club and to be used as described in our photography policy (available on request).

  Yes No