Booking

The Green Outdoors Club – Summer Holiday Club

July 24th – July 28th

Please book your spaces below.

Name(required)

Address(required)

Email(required)

Phone Number(s)(required)

Child Name(required)

Child D.O.B(required)

Child Name (2)

Child D.O.B (2)

Child Name (3)

Child D.O.B (3)

Dates(required) Monday July 24 Tuesday July 25 Wednesday July 26 Thursday July 27 Friday July 28 Whole Week

Other Dates: Please specify below

Hours(required) 8am to 5pm 9am to 5pm 8am to 6pm 9am to 6pm

Dietary Requirements

Medical Information/Any health restrictions or current treatment (please inc. asthma & hay fever)

Is your child allergic to anything?

National Health Number

Doctor's Name & Address(required)

Emergency Contact Name(required)

Emergency Contact Telephone(required)

Emergency Contact Email

Questions/Comments

1. I give my permission for my child to participate fully in the Green Outdoors activities.(required)

2. I will inform the event leaders if my child has been in contact with any infectious diseases within three weeks prior to the event.(required)

3. I give my consent for my child to be given basic First Aid treatment by a member of the Leadership Team should an accident occur.(required)

4. If it becomes necessary for my child to receive medical treatment and I cannot be contacted by telephone or any other means to authorise this, I hereby give my general consent to any necessary medical treatment and authorise the Leaders to sign any document required by the Hospital authorities.(required)

5. I am happy for photographs of my child to be used in The Green Outdoors publications.(required)

Are you the child’s legal parent or guardian?(required)

Parent or Guardian Name(required)

Date(required)

I understand the questions on this form and have given replies to them.(required)

Thank you for contacting us, we will respond very shortly.