Easter Holiday Programme 2013
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Transcript of Easter Holiday Programme 2013
BVAL_EasterHolidayProgramme.job 03/13/2013 14:27:37 Composite Sheet: 1 Side: A
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For a free BVAL holiday card for your child please complete the registration form below and hand into reception at any BVAL
centre. Once the form is completed you will be given a card which will enable your child to book onto all future holiday
activities.
Name of child: ................................................................... DOB: ........................................ AGE: .................
Male � Female School Attending: ...................................................
Contact Name .................................................................... Tel ..........................................................................
Emergency contact name and numbers ...............................................................................................................................
Email address .....................................................................................................................................................................
Address ................................................................................................................................. Postcode .............................
Does your child have any medical conditions/allergies?
Or take any medication which we should know about? Yes �No �
If yes, please specify ..........................................................................................................................................................
Do you consider your child to have a disability? Yes �No �
If yes, please give details ....................................................................................................................................................
Ethnic Origin (please circle the appropriate)
White Black - Caribbean / African / Caribbean / UK / Other Asian-Indian
Asian-Pakistani Asian-Bangladeshi Asian-Chinese Other (please specify)
Religion .................................... How did you find out about BVAL? ....................................................................................
I hereby give consent for my child to be given a BVAL holiday card which will enable my child to be able to attend future
activities organised by BVAL. I will keep BVAL up to date with any changes to my child's details eg medical conditions etc.
I understand that while involved in the delivery of these activities personnel will take every reasonable precaution to ensure
that accidents do not happen, they cannot be held responsible for any loss, damage or injury suffered by my child.
I give my consent that in an emergency situation, BVAL may act in my place, (in loco parentis), if the need arises for the
administration of emergency first aid and / or other medical treatment which in the opinion of a qualified medical practitioner
may be necessary. I also understand that in such an occurrence all reasonable steps will be taken to contact me as the
relevant parent / legal guardian.
I am aware that during activities photographs and videos may be taken for promotional use (including the internet) by BVAL
and agencies working in partnership with BVAL (If not in agreement please enclose a letter stating this).
In accordance with the Data Protection Act 1998 the information you give us will be held on our database for the purpose of
supplying you with information regarding future activities and for monitoring your attendance and evaluating the
programme.
If you do not wish to receive this information please tick this box �
Signed ......................................................................... Parent/Guardian/Carer Date .....................................................
�
Holiday Card Registration Form
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