St John's Church, Owlerton

Contact details

Child's Name (required)

Child's Age (required)

Child's School Year (required)

Address (required)

Contact number

Contact email

If you would like your child to be put in a group with a friend / sibling please indicate their name here. We will do our best to accommodate you.
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Consent (required)

My child will be bringing a packed lunch each day.

I givedo not give permission for any appropriate first aid to be given by the nominated first aider. In an emergency, if I cannot be contacted, I am willing for my child to be given hospital treatment, including anaesthetic.

I givedo not give permission for photos of my child to be taken during
the event and used for St John’s Church publicity.

Parent's Name:

Emergency contact (required)

In the event of an emergency, please provide details of an additional
named person who could be contacted. Please ensure you have
discussed with them first.

Name:

Number:

Address

Health Information

Please indicate any medical conditions your child and of which you would
like us to be aware. E.G Asthma, diabetes, epilepsy, hay fever etc

Please indicate any allergies your child may have E.G Nuts, face paint etc

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Please check this form before submitting

By submitting this form you consent to your child attending the ‘Mission: Rescue Holiday Club’ from 9.45am – 12:30pm at St John’s Church, Owlerton, Penistone Road, Sheffield and acknowledge that all information given is correct.