Summer Club Registration - Orchardhill Parish Church

Child's Name *

Address *

Parent/ Guardian's Name *

Home Telephone number

Parent/Guardian Mobile Number *

Email Address for summer club updates only. *

Second Emergency contact during club (Name, number relationship to child) *

Childs D.O.B. *

School *

Year Class after summer break e.g. P6, P4. *

Name and Number of childs G.P. *

Any illnesses or other medical conditions (e.g.Asthma) allergies/ medication which may affect normal activity? *

In the event of illness or accident, if neither I, nor the emergency contact can be contacted. I give permission for my child to receive any necessary medical treatment from a qualified First Aider or medical practitioner. *

I Agree

No I do not Agree

I understand that the Summer Club activities will take place in the Church Halls and grounds, with appropriate supervision. *

I Agree

I give permission for photographs to be taken, which may be used in Church or Orchardhill Parish Church publications. *

yes

no

If there are any other details that you think we should know please enter them here.

My Child on Monday 4th August will be: *

Arriving 8:30am for Breakfast and Club on Monday

Arriving 10:00am for the Club only on Monday.

Not Attending on Monday

My Child on Tuesday 5th August will be: *

Arriving 8:30am for Breakfast and Club on Tuesday

Arriving 10:00am for the Club only on Tuesday.

Not Attending on Tuesday

My Child on Wednesday 6th August will be: *

Arriving 8:30am for Breakfast and Club on Wednesday

Arriving 10:00am for the Club only on Wednesday

Not Attending on Wednesday

My Child on Thursday 7th August will be: *

Arriving 8:30am for Breakfast and Club on Thursday

Arriving 10:00am for the Club only on Thursday

Not Attending on Thursday

My Child on Friday 8th August will be: *

Arriving 8:30am for Breakfast and Club on Friday

Arriving 10:00am for the Club only on Friday

Not Attending on Friday

Don't worry if you want to change the above Just let Lorna know a couple of days before. Youthandfamily@orchardhill.org.uk

by checking this box you are electronically signing this form as a true statement and enrolling your child for the 2025 Orchardhill Summer Club

I Agree Please Enroll my child.

Orchardhill Summer Club Registration Form