GROUNDBREAKERS REGISTRATION FORM (ONE FORM PER CHILD) by dfhrf555fcg

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									                                   Treasure Seekers
                     th
     Monday 27 July - Saturday 1st August @ Old Parish & St Paul’s
                               Church
                                Scott Crescent, Galashiels
                          from 6pm till 8pm (doors open 5.45pm)
                                     Admission Free!

    Return forms with payment to book a place to: Gail Fox, Park View, 39 Cotgreen Road,
      Tweedbank, Galashiels, TD1 3SG. Places allocated on a 1st come, 1st served basis.
           e-mail gailmfox@hotmail.com or phone 01896 753433 for more details.

     Please note: You will only be contacted beforehand if there are no spaces available.

                                   Treasure Seekers
                    Registration and Consent Form             (ONE FORM PER CHILD)


Childs Full Name                                                           Date of Birth


Address                                                                    Home phone number




School                                             Class (just completed)               M/F


Emergency Contact: (if different from above or mobile number for contact during club)



GP’s Name                                                           GP’s Phone number


Any Known allergies or conditions




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 appropriate first aid to be
given by the nominated first-aider. In an emergency and if I cannot be contacted, I am willing
for my child to be given hospital treatment, including anaesthetic if necessary. I understand
every effort will be made to contact me as soon as possible.


Signature of Parent/Guardian                                               Date

								
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