Blackburn and Seafield Church

Holiday Club

OnLine Registration Form.


Rocky's Plaice

(please use a separate form for each child)

The Holiday club will take place at Blackburn & Seafield Parish Church from 5th – 9th August, 10.30 – 12.30pm daily

Please fill in this form to book a place for your child (details of where to send it in leaflet)


Basic Information

Child's First Name
Child's Surname
Date Of Birth

Contact Details

Post Code
E-mail Address
Telephone Number (Including Area Code)
Mobile Number (Parent Or Guardian)
The child may be collected by
May The child go home unaccompanied at the end of each session?

Your child should be collected from holiday club each day by an adult. If your child is being collected by someone different each day, please let the leader know at registration.


School Information

School Year

Emergency Contact Information

Emergency Contact Name
Emergency Contact Telephone Number (Including Area Code)
GP's Name
GP's Telephone Number (Including Area Code)
Any Known Allergies Or Health Problems?


I give my consent for my child’s photo to be taken during the holiday club with the understanding that photos may be used to promote the holiday club, in the church newsletter, church website and Facebook page and as part of our photo collage in Church and on the Friday Family evening.

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 necessary medical treatment to be given by the nominated first-aider. In an emergency and if I cannot be contacted, I am willing for my child to receive hospital treatment, including anaesthetic if necessary. I understand that every effort will be made to contact me as soon as possible. By clicking "submit" below, you give us permission to enter this information into the church database.


All details entered here will be sent to Elaine Wood and Tracy Newall.