Child's Name (required)

Date of Birth (required)

Parent's Name (required)

Email (required)

Medical (allergies / injuries) (required)

Other (behavioural / SEND) (required)

Emergency Contact 1 (Name and Phone) (required)

Emergency Contact 2 (Name and Phone)

**Optional - Request to be with Friends (Please name up to two friends you wish to be in a group with)

Please indicate the dates you wish to book for HALF TERM CAMP:
Mon 25th OctTue 26th OctWed 27th Oct

I hereby give my permission for the qualified coaches employed by Woodstock Gymnastics Club to act in loco-parentis in the event of an emergency.

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