in the wild registration form

Refuge Church looks forward to welcoming you to IN THE WILD holiday club!*

  • Monday—Thursday | 15–18 July 2019 | 2–4pm | Pollokshaws Burgh Hall

Please complete the registration form below, thanks!

*for kids who have completed P1–P7


Name of Child 1 *
Name of Child 1
Name of Child 2
Name of Child 2
Name of Child 3
Name of Child 3
Parent/Guardian Details
Name of Parent/Guardian *
Name of Parent/Guardian
Address *
Address
Home Phone
Home Phone
Mobile Phone *
Mobile Phone
Additional Emergency Contact Details
Name of Additional Emergency Contact *
Name of Additional Emergency Contact
Additional Emergency Contact Phone *
Additional Emergency Contact Phone
Further Information
GP Phone
GP Phone
Please let us know of any allergies or intolerance, type N/A if none—(if enrolling more than one child, please make it clear which child the allergy/intolerance relates to)
Please let us know of any additional support needs that your child(ren) may require, type N/A if none
please use this space to let us know any other relevant information