Holiday Club Registration Form

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Childs Name: *

Parents Name: *

Address: *

E-mail address: *

Telephone *

Childs Age: *

Date of Birth *

Gender

Check this box if you agree to Lift Off! keeping a copy of your personal data.

Check box if we can photograph your child

Does your child have any allergies? *

Does your child have any other dietary preferences?s *

Does your child have any additional needs? *

Any other information we should know about your child? *

How did you hear about the Holiday Club? *

Do you attend a local Church? If so which one?

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