Holiday Club Application Form

ONLINE APPLICATION FORM FOR HOLIDAY CLUB

* Indicates required field

Parent / Carer #1 *

First

Last

Parent / Carer #2 *

First

Last

Email *

Home Phone Number *

Mobile Phone Number *

Address *

Child's Year Group & Class Name *

Child Name *

First

Last

Date of Birth *

Select One *

Emergency Contact #1 *

Emergency Contact #2 *

Name & Telephone no: of Family Doctor *

In the case of an emergency, it might be necessary to obtain urgent treatment for your child from a doctor, dentist or hospital casualty department. As delay in such circumstances is to be avoided, in the unlikely event of GNRC Limited not being able to contact you, we ask that you give your consent thus: “In the event of a sudden illness or accident affecting my child, I agree to emergency treatment if recommended by a doctor, including any operative treatment and/or administration of a general anaesthetic.”

Has your child got any special dietary requirements or allergies? *

If Yes, please give further information *

Emergency Medical Consent Given *

Yes No

Has your child got any medical needs? *

If Yes, please give further information *

Please tick for Holiday Club Only *

Holiday Club Only

We will confirm your start date once your application form has been processed.

I have read and agreed to the Greenway Nursery Rainbow Club Terms and Conditions. *

Yes No

I consent to photographs of my child being used online and on GNRC's literature. *

Yes No

Please tell us how you found out about us *

Submit