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Holiday Club Registration Form 2022

DOAD Title logoOur  Diary of a Disciple Holiday Club will be running from Monday 8th August to Friday 12th August 2022, 9am-3pm. Five fun days of sport, craft, music and Bible teaching at Harwell School for children currently in Reception to Year 8. Free but donations are welcome.

You can register your child for Holiday Club NOW using the form below.

Because Holiday Club is such a popular event we are often oversubscribed and places are allocated according to our Admissions Policy which you can view here. 

If you would like your child to attend the week, please complete the form below (a separate form for each child you wish to attend). Remember to click the 'Send' button once complete. If your submission has been logged, an acknowledgement message will then appear.

Child's First Name: 
Child's Surname: 

Child's Date of Birth: 

  (Date)
   (Month)
   (Year)
Any Special Needs?:   e.g. allergies or conditions 

(If yes, please specify): 
School Attended:

(If 'Other', please specify):

If a member of an uniformed organisation in Harwell or Chilton, e.g Cubs/ Guides, please specify name of group here: 



 
  • I give my consent for my child to swim under the supervision of a qualified lifeguard 
  • I give my consent for my child to be photographed during Holiday Club and for photos to be used on the church website & social media pages, and in projected & printed material, e.g. church annual report 
  • I give my consent that in the event of illness or accident any appropriate first aid may be given to my child by the nominated first aider. In an emergency, if I cannot be contacted, I consent to my child being given hospital treatment including anaesthetic if necessary. I understand that every effort will be made to contact me as soon as possible 
  • I give my consent for my child to go home unaccompanied after Holiday Club each day   If "No", please provide a Collection Phrase/Password (we will release your child to an adult who can provide this phrase/password): 

Parent's Name: 

Address: 
 

Town: 

Postcode: 

Telephone: 

Mobile: 

Email Address: 

 

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