REGISTRATION FORM ActionPak 2008
NB: All telephone numbers completed below to not have any gaps please.
Child's Full Name*:
Sex of child: Male
Female
Date of Birth*:
Age:
Home Address*:(please include postcode)
Home Tel*:
Parents' Email:
Mother's name*:
Place of work:
Work Tel:
Mobile:
Father's name*:
Place of work:
Work Tel:
Mobile:
3rd Emergency Contact*:
Tel*:
4th Emergency Contact:
Tel*:
Child's Doctor*:
Address*: (please include postcode)
Tel*:
Known Allergies:
Other information we should know about your child:
Ethnic Religion:
School*:
Please indicate how you heard about ActionPak:
I hereby give my consent for the above named child to take part in swimming, sports activities and trips to various destinations as part of ActionPak.
Agree
Disagree
I also give my consent to allow any Medical Attention that my child may require.
Agree
Disagree
Relationship to child*:
Today's Date:
Form Completed By:
(Parent/Guardian)
Persons permitted to collect my child*:
Registration Form per child
Preferred Group: 4-5
5-6
6-7
8-9
9-10
11-14
Holiday Care:
day(s), at
£27.00 per day
Total £
Siblings:
day(s), at
£22.00 per day
Total £
(Optional: Places may be limited)
Horse Riding:
day(s), at
£15.00 per
Total £
We occasionally require photography for future publicity materials.br> If you DO NOT wish your child to appear in these photos please tick here
Swimming:
Can your child swim unaided at least 20m without armbands? Yes
No
Please give detailed information on your child's swimming ability:
Please tick all dates to be attended
Easter March / April 2008
Tues 25th
Wed 26th
Thur 27th
Fri 28th
Mon 31st
Tues 1st
Wed 2nd
Thur 3rd
Fri 4th
Summer July 2008
Mon 21st
Tues 22nd
Wed 23rd
Thur 24th
Fri 25th
Mon 28th
Tues 29th
Wed 30th
Thur 31st
Fri 1st August
Summer August 2008
Mon 4th
Tues 5th
Wed 6th
Thurs 7th
Fri 8th
Mon 11th
Tues 12th
Wed 13th
Thurs 14th
Fri 15th
Mon 18th
Tues 19th
Wed 20th
Thurs 21st
Fri 22nd
Tues 26th
Wed 27th
Thurs 28th
Fri 29th
