0116 230 2626
Email the Church





Please email the form below to the Church Office/Administrator asap:

welcome@rothleychurch.org.uk or phone 0116 2302626

to request a booking form.  Note: Places are limited.









Awesome Easter Holiday Club Booking Form

Tuesday 26th March 2024, 9 am - 3.30 pm


Child’s Name:                             Date of birth:


School attended:             School year:


Child’s Home Address:



Name, Contact phone number of a parent and an alternative relative or close friend during the event  (please state how the child knows them) in case of emergency:



Name of adult collecting my child at 3.30 pm:


Please give details of any special needs or allergies, dietary needs etc about which we need to be aware during the day:

Note: It may be necessary for a one-to-one carer to attend for certain special needs to be met.

Please tell us everything we need to know to care for your child in the way you would wish us to.

Please send any inhalers, epipens etc as required, clearly labelled with your child’s name:






Please note that we will be supplying drinks of water/squash and biscuits/small cakes during the day. Please let us know if there is anything you would prefer your child to have/not have to eat or drink:



I enclose £5 cash, which I understand will be returned in the event of numbers being exceeded or the event being cancelled (please tick)


Medical Emergencies:

If it becomes necessary for my child to receive medical treatment and I cannot be contacted by telephone or any other means to authorise this, I hereby give my general consent to any medical treatment and authorise the specified leaders in charge of the church group to sign any document required by the hospital authorities. 1


Signed _______________________________________(parent/guardian)         Date ___________________________



Please print name: _______________________________________________________________________________________


1 The medical profession takes the view that the parent’s consent to medical treatment cannot be delegated. This view is explicit in the Children Act 1989. Thus medical consent forms have no legal status and a doctor/nurse insisting on the consent of a parent to a particular treatment has the right to do so. For this reason it is recommended that Leaders do not insist on parents signing the statement above. However, it can be a comfort to medical staff to have a general consent in advance from parents or to have a leader on hand to sign forms required by medical authorities

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