Mega Makers Registration | Pinner Parish Church

Name of child attending
(First and Surname) *

Gender
*

FEMALE

MALE

Date of Birth *

DD/MM/YYYY

Age (on 25th July 2016) *

Address *

Emergency Contact Number

HOME *

MOBILE *

ADDITIONAL MOBILE

Does your child have any medical problems or learning difficulties of which we should be aware? *

YES

If 'YES' please give details.

Will your child be bringing any medication with him/her during the week? *

YES

If 'YES' please give details

Name of Parent/Guardian *

E-mail address *

Groups

If your child has a strong preference to be in the same group as another child (in the same age category: 4-5s, 6-8s, 9-10s), please state their name(s) and we will do our best. (Please do not put more than 2 names)

Permission *

I give permission for my child to attend and participate in the Mega Makers Holiday Club which will take place at Pinner Parish Church Hall from Monday 25th July to Friday 29th July 2016. If it becomes necessary for my child to be given urgent medical treatment and I cannot be contacted by telephone or any other means to authorise this, I hereby give my general consent to any medical treatment judged to be necessary by a medical practitioner or registered first aider and I authorise the leader in charge to sign any document required by hospital or other authorities.

Temporary Tattoo
*

During the week there will be an opportunity for your child to have a temporary tattoo on their arm.

Yes I am happy for my child to have a temporary tattoo on his/her arm

No I do not wish my child to have a temporary tattoo on his/her arm.

Photography *

We will be taking photos/videos during the week which may be used in Pinner Parish Church publications and may be used on our website (no names will be published). In order to comply with the Data Protection Act 1998 we seek your express consent to the use of Personal Data relating to your child by the Church for the purposes set out below.
I give permission for photographs/videos of my child to be used in Pinner Parish Church publications and Pinner Parish Church website.

Yes

T-Shirts *

You can order a Mega Makers T-shirt for your child to wear during the week and to keep as a momento of their time at Holiday Club 2016. T-shirt cost £4 each. Please tick the box:
(NB if you are ordering a t-shirt please select your child's age group)

No T-Shirt Required

4-5s

6-8s

9-10s

Donation

We ask for a donation of £18 per child to cover the cost of the activities during Holiday Club week.

Donation *

If a space becomes available I will be sending £22 (donation + t-shirt) cash/a cheque made payable to Pinner Parish Church.

If a space becomes available I will be sending £18 (donation) cash/a cheque made payable to Pinner Parish Church.

If a space becomes available I will be unable to make a donation

Please check all the above information you are about to submit is correct!

If you are sending a donation/t-shirt money please make cheques payable to:
Pinner Parish Church

and send to:
Mega Makers Holiday Club
Pinner Parish Church
Church Lane
Pinner
HA5 3AA

You will get an email confirming your child's place once you donation is received.