Please complete this form to register your child for the Backpackers holiday club. Child's Full Name * Child's Age * Your Name * Please provide emergency contact details where you can be contacted during the holiday club. Emergency Contact Number * Emergency Contact Address * Allergies / Medical Conditions Please state whether there are any medical conditions or allergies that we should know about (eg asthma, allergies, medication etc.) Child Will Be Collected * Yes No Is your child to be collected at the end of the holiday club? If so please provide name/relation of the person collecting your child. Who will collect your child? (If Applicable) Who is responsible for collecting your child at the end of the holiday club. I give permission for the above named child to attend the Backpackers Children’s Holiday Club on Monday 29th July to Friday 2nd August in Bellevue Chapel from 10:00am to 11:45am each morning. In the unlikely event of illness or accident, I give permission for any appropriate first aid to be given by the nominated first-aider. In an emergency, and if I cannot be contacted, I am willing for my child to be given hospital treatment, including anaesthetic if necessary. I understand that every effort will be made to contact me as soon as possible. During the Holiday Club, cameras may be used and I have no objections. I Agree * Please tick the box confirming that you agree to the statement above and click submit to register your child for the holiday club. The information that you have provided above will be used entirely in relation to the running of the holiday club and will not be retained beyond that time. CAPTCHABefore submitting the form please verify you are not a robot.