Please complete a seperate form for each child and return your form to Alli Ward/Helen McLaughlin or Andrea Hines at Nuneaton along with a deposit of £30 per child. I/We give permission for my child to be part of Camp Danger! 2011 at Lifechurch, Bedworth from

Monday 25th – Friday 29th July 2011.Childs Full Name

(All information is held in confidence) Age: D.O.B: Male/Female:Full Address

Home Phone Number

Parents/carers Mobile Number

Emergency Contact Name & Contact Number

Name, Address & Phone Number of family doctor

Date of last tetanus injection

Details of any illness/disabilityIncluding asthma, epilepsy, hayfever, diabetes etcWhat special care is needed?

Details of any medication needed during time at camp

Your child can register each day from 8.30am. What time approx will your child arrive?

If you need your child to stay after 4pm - What time approx will your child be collected? (No later than 5pm)

Will you child attending breakfast club? Please tick

MON TUES WED THURS FRIDAY

Details of any allergies or diet requirements eg Penicllin, foods Vegetarian etc

Will your child be attending each day? Please tick.Please note: Our day trip on 27TH July is subject to full week registration.

MON TUES WED THURS FRI

Please tell us who some of your child’s friends are , this will assist with group organisation

£75 for the full week.Cost per day is £15. Please remember that our trip on Wednesday 27th July is subject to full week registration.

PLEASE TURN OVER AND SIGN PERMISSIONS – THANK YOU

Lifechurch. BULKINGTON RD. BEDWORTH. CV12 9DG. TEL 024 7649 4320

CampCamp Danger! 2011

PARENTAL/CARER PERMISSIONAll medication should be labelled with your child’s name, the dose to be taken and when it should be taken and handed in to the registration desk each morning. If your child requires a puffer for asthma, or insulin for diabetes, they are to carry their own medication in a waist bag with instructions; this must be done with both the knowledge and approval of the camp organisers and yourself.

I understand that camp leaders will do what is necessary to ensure my child’s safety and take all reasonable care of them during the camp. Accordingly I approve my child’s attendance and agree not to hold Lifechurch, or its leaders, responsible for any circumstance that may eventuate.

Please tick Yes No

I give permission should any accident or illness occur, where it is impracticable to communicate with me, to my child receiving medical, dental or surgical treatment as may be deemed necessary by a professional.

Please tick Yes No

Children must abide by camp rules. I agree to my child being sent home if they continually disregard these rules, or if in the opinion of the Leader In Charge, there is non-cooperation of any description. I understand that such an arrangement may be necessary due to illness or injury also.

Please tick Yes No

I give permission for my child to travel (via coach/car/mini-bus) on a day trip to the place specified and to taking part in activities during the visit. I understand that during the visit my child will be under the control and care of the group leader and other adults approved by Lifechurch and while all staff will take all reasonable care of any child, they cannot be held responsible for any loss, damage or injury suffered during or as a result of the activity.

Please tick Yes No

I am happy for my child to be photographed and those photographs used in the future for publication or publicity including church website.

Please tick Yes No

PARENT/GUARDIAN’S SIGNATURE: ___________________________________________

DATE: _________________

* Deposits are non-refundable

Lifechurch. BULKINGTON RD. BEDWORTH. CV12 9DG. TEL 024 7649 4320