Kids Keswick Registration Form

Please complete this form and send it with payment to the address which appears at the bottom of the page


Name of Child: __________________________________________Date of Birth: ___/___/___

School year________________

Name of Parent(s): _______________________________________

Address:________________________________________________________________________________

________________________________________________________________________________________

Tel: ________________________________ Mobile: _____________________________________________

Emergency Contact:_______________________________ Tel: ___________________________________

Does your child have any allergies, conditions or needs we need to know about? ______________________

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Cost: £3 per child - Max: £10 per family

Do you give your consent for medical treatment in the event of an emergency? YES / NO (*)

Do you give your consent for photographs of your child to be used in
any publicity, J.E.P., website etc: YES / NO (*)

(*) = Please delete as appropriate

Signature……………………………………………………

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Francelise Gallaher,
‘Pine Needles; 6, Le Clos De Mon Sejour, Trinity Hill, St.Helier, JE2 4NZ
Tel : 725425