Form Sig Test How many children will be attending Holiday Club? Number of Children * 1 2 3 4 Childs details First Name * Last Name * D.O.B * Address Line 1 * Address Line 2 City/Town * Postcode * Second Child's Details First Name * Last Name * D.O.B * Third Child's Details First Name * Last Name * D.O.B * Fourth Child's Details First Name * Last Name * D.O.B * Which Holiday Club are they attending? HC Location * Healaugh Which days can they attend? Availability Monday Tuesday Wednesday Thursday Friday Medical/Dietary requirements that we should be aware of: Medical / Dietary Needs Parent/Guardian Details Full Name * Address if different from above Contact Number * Email I (the parent/guardian) give photo and video consent to the Bridge Project Tadcaster and St John the Baptist Healaugh to use my child's image in its print and online publications: This consent allows the use of photos and video for promotional purposes, for the next 12 months and are not shared with 3rd parties. Photo & Video Consent Yes No I (the parent/guardian) give consent for the Bridge Project Tadcaster and St John the Baptist Healaugh to store the personal data entered into this form until the end of the Holiday Club, July 27th 2018. This data is stored securely and is not shared with 3rd parties. Data Consent Yes No Verification reCAPTCHA Parent/Guardian Signature * Draw It Clear
