Southern Cross Holiday Club

Please complete both pages and bring to the holiday club  

HOLIDAY CLUB Registration Form
(please use a separate form for each child)

Child’s full Name


 Sex: M/F

Date of Birth


Please register my child for the Holiday Club 

Parent’s/guardians signature

Legal Guardian                                                                                                     Phone number

Parent’s/Guardian full name


Postal Code

Home phone number

Mobile number

Works phone number

Other emergency number


I give permission for my child’s and my details to be entered on the Holiday Club database Yes/No

I give permission for my child's photo to be used on the boards in the church hall  Yes/No 

I give my permission for my child's photo to be featured on the website  Yes/No









 Emergency Contact Details


Emergency contact name

Phone number

GP’s Name


GP’s phone number


Any Known allergies or condition.


I confirm that the above details are complete and correct to the best of
my knowledge.

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.


Signature of Parent/guardian:


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