Holiday Camp Form

Your Name

Your Email Address

Child Full Name

Child Date of Birth

Address

How did you hear about us? How did you hear about us? La Marelle Grenadine Website Social Media Word of mouth Leaflet Other

Select days child will attend Select days child will attend 27/05 (9:30-3:30pm) 27/05 (9-4:30pm) 28/05 (9:30-3:30pm) 28/05 (9-4:30pm)

Parent/Legal Guardian Full Name

Parent/Legal Guardian Phone

Relationship to child

Emergency Contact Full Name

Emergency Phone

Medical Conditions / Allergies

Medication Required

Emergency Treatment Consent Emergency Treatment Consent Yes, I give consent No, I do not give consent

I give my consent for my child to participate in all activities organised by Les Petits Molières Ltd.

I acknowledge that participation involves inherent risks, including risk of injury arising from physical activity, travel, and organised sports.

I understand that Les Petits Molières Ltd cannot exclude liability for death or personal injury caused by negligence. However, to the fullest extent permitted by law, I agree that they shall not be held liable for any other loss, damage, or injury except where caused by negligence or breach of statutory duty.

I confirm my child is medically fit to participate and that I have provided all relevant medical information

By signing below you agree to the above.

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Contact us

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Email Address

[email protected]