Child's Name:

Childs D.O.B:

Address:

Is your child a pupil at SMH:
yesno

Parent Name:

Email:

Tel No:

Does your child have any dietary requirements?
yesno

Please specify

Does your child have any medical conditions?
yesno

Please specify

Date of your child’s last tetanus injection:

Emergency Contact:

Emergency Contact Number:


Dates – Please tick to register which weeks you wish to send your child(ren).
Tuesday 18th February Full DayTuesday 18th February Half DayWednesday 19th February Full DayWednesday 19th February Half DayMonday 30th March Full DayMonday 30th March Half DayTuesday 31st March Full DayTuesday 31st March Half DayWednesday 1st April Full DayWednesday 1st April Half DayThursday 2nd April Full DayThursday 2nd April Half DayFriday 3rd April Full DayFriday 3rd April Half Day

Please use the space below to detail any additional information you would like to provide including any single-day booking dates.

I consent to the use of photographs/videos taken of my child for the use of publicity by means of the school website, Holiday Camps and Courses brochure and Stonyhurst social media, i.e. facebook and twitter. Stonyhurst will not publish any personal details of my child in this publicity, i.e. name, address etc.
yesno

We take your privacy seriously and will only use your personal information to administer your account your account and to provide the products and services you have requested from us.

However, from time to time, we would like to contact you with details of our special offers and promotions. If you consent to us contacting you, for this purpose, please tick to say how you would like to be contacted.