Sign up for Pyramid Rock Holiday Club

Pyramid-Rock     27th-30th August 2019, 9.30am - 12pm (with Family Fun Afternoon on 29th August 12-2.30pm)

For children who were in Reception-Year 6 in the 2018-2019 school year.
Please fill out one form per child, thanks!


Child's First Name:
Child's Surname:
Date of Birth:
Address Line 1:
Address Line 2:
Preferred Contact:
School year 2018-19
Other children your child knows who are coming:
Allergies/Dietary Requirements/Medical Conditions:
Any Other Information:
Photographs may be taken at this event. These images may appear in our printed publications, on our website, or both. No names will be printed. To comply with the General Data Protection Regulation, permission must be granted by the parent/carer before any images of your child/children are taken and used. Please answer questions 1, 2, 3 and 4 below.
Permission to take photos/video of your child:
Permission to use images in printed/video publicity:
Permission to use images/video on SMB Children Facebook page/Twitter account:
Permission to use images/video on SMB website:
(Please note that websites can be seen throughout the world, and not just in the United Kingdom, where UK law applies.) Please tell us how we can contact you about other children's/family events happpening here:
Text message
In an emergency and/or if I am not contactable, I am willing for my child to receive doctor/hospital or dental treatment, including an anaesthetic:
GP name:
GP Phone number:
Name of parent/guardian with parental responsibility:
Contact number during Holiday Club:
I confirm that I will pay £8 for the week by:
Method of payment:
Account name: St Mary Bredin PCC.
Account number: 00477227
Sort code: 30-91-60
Please mark payment 'Pyramid'.
If you have any questions about payment, please speak to Mim (
I give permission for my child to take part in the normal activities of this group. I understand that while involved he/she will be under the control and care of the group leader and/or other adults approved by the church/organisation leadership and that, while the staff in charge of the group will take all reasonable care of the children, they cannot necessarily be held responsible for any loss, damage or injury suffered by my child during, or as a result of, the activity.

In completing this form I understand that I am reserving a place for my child at Pyramid Rock, and the place will be confirmed when payment has been received.