St John's a growing Anglican, evangelical church in Weymouth

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To book your place on the Connect Kids Club 5.15 pm for years 5 & 6 please complete the form below.

"*" indicates required fields

Name of child*

School year*

Emergency contact name A*

Emergency contact A number*

Emergency contact name B

Emergency contact B number

Does the child named above have any allergies we need to be aware of?*

Yes

No

Please specify*

Does your child have any other special needs we need to be aware of?*

Yes

No

Please specify*

I give consent to medical treatment being given to my child*

Tick to confirm

I give permission for my child to arrive and leave on their own

Tick to confirm

I give my consent for my child to receive a drink and snack*

Tick to confirm

Your name*

Relationship to child*

Parent

Other family member

Guardian

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