Holiday Club Parental Permission

To secure a place on Rebecca’s Holiday Club, please complete the secure online form below or download, complete and return to us a MS Word or PDF file Parental Permission form.

Please read through this sheet carefully. Ticking the boxes and submitting this secure online form is providing us with your consent for your child to attend Holiday Club and tells us that you have read and understood all of the terms by which your child will be child will be cared for.

    Parent/carer's name (required)


    Parent/guardian/carer's email address (required)

    Child's name (required)

    Child's date of birth (required) (DD-MM-YYYY)

    Please could you read and tick the following statements to give your permission for the following (if appropriate):


    Gaming devices

    Sun Protection



    I that my child's images can be included on the Website and facebook pages for Rebecca's Scrap book.


    Occasionally we will watch U rated films. I that my child can watch these films.

    Bouncy Castle

    Dislclaimer: (Bouncy Castle) The guidelines are always at the reception table, and are for the safety of all children using this equipment: Rebecca's staff ensure the special conditions are fully adhered to at all times.

    Our company Cannot accept any Responsibility for any injury caused to anyone using this equipment.


    Information Sharing

    *Except in Child Protection cases where it is judged that the child may be placed further at risk.

    First Aid

    Administration of Medicine


    Emergency Action

    *Please state if there are any exceptions to this i.e. blood transfusions and give details:


    Signature (Please type your name):

    Date DD-MM-YYYY:

    Rebecca's Parental Permission
    Rebecca's Child Info Form PDF
    Contact Us

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