Sid Valley Mission Community

 Child's Full Name:   

 Child's Date of Birth: 

 School Year Just Completed summer 2017:

 Email Address: 

Home Address:

 Name of Emergency Contact: 

 Emergency Contact Number: 

 Relationship to Child: 

 Are you willing for your child to be photographed for publicity purposes (church noticboards, church website, church magazine)? 

 Yes 

 No 

 Are you willing for your child to be photographed and for the photograph to be displayed on Facebook (just All Saints page with no tagging)?

 Yes 

 No 

 Please provide details of any allergies, medical problems, special needs or other relevant information.