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Name of Child
*
Current School Year
*
Child's Address
*
Postcode
*
Date Of Birth
*
Male
Female
Name of Parent/guardian
*
Phone Number
*
Church Attended (if any)
Email address
*
Emergency Contacts. You or your alternative emergency contacts must be contactable and available to come to site at all times
Emergency Contact Name 1
*
Emergency Contact Name2
*
Emergency Contact Number 1
*
Emergency Contact Number 2
*
Names of up to TWO children He/She would like to be with.
Which days do you want to attend?
*
Monday (30th July)
Tuesday (31st July)
Wednesday (1st Aug)
Thursday (2nd Aug)
Friday (3rd Aug)
Any allergies or other medical, educational or social special needs?
*
It is very important that you make a full declaration of these.
Please select
*
Yes - please send additional details
No
Inhaler
*
Yes
No
EPIPEN/EMERADE/JEXT
*
Yes
No
Name and address of Doctor
*
Doctor Contact number
*
Important
*
I agree to my child attending Detonate 2018 and I give permission for Detonate to give or authorise medical treatment if considered necessary.
I will not remove my child before the end of the day without first notifying their Age Group Leader.
I will not send my child to Detonate within 24 hours of any sickness
Gift Aid Declaration
Please treat my donation as a Gift Aid donation
Date form completed
Please PRINT name as signature
Online Booking and Payment coming soon.
