SummerFest Registration FormThis is a registration form for SummerFest 2018 from the 6th till the 10th of August. More information is available at www.lpc.ie

Child's Full Name

Child's Date of Birth

Address

Name of Child's Parent/Guardian

Email of Parent/Guardian

Home Phone Number of Parent/s

Mobile Phone Number of Parent/s

Second Contacts Name (Optional)

Second Contacts Relationship to Child

Second Contacts Number

Dietary requirements

Medical Conditions relevant to child

Can Photos/Videos of your child to be taken

Yes

Can photos/videos of your child to be used for Church purposes?

Yes

I hereby confirm the above details are correct

Yes

Signature