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Sunday Club Registration
Registration and Consent Form
Email address *
I agree to being contacted via email
Anything written on this form will be held in confidence. The leaders need to know these details in order to meet the specific needs of your child.
Child's full name: *
Your answer
Group: *
DoB: *
Your answer
Name by which child is usually known: *
Your answer
Address: *
Your answer
Postcode: *
Your answer
Emergency Contact Name: *
Your answer
Relationship to Child: *
Your answer
Emergency Contact Number:
Home: *
Your answer
Mobile: *
Your answer
If unavailable contact:
Alternative Contact Name: *
Your answer
Phone Number: *
Your answer
Relationship to Child: *
Your answer
Name and phone number of GP:
Name: *
Your answer
Address: *
Your answer
Phone Number: *
Your answer
Details of any known conditions, allergies etc *
Required
Notes of any medication being taken: *
Your answer
**Details of any special needs, requirements or directions that would be helpful for the leaders to know about:
Your answer
In the event of illness or accident, having parental responsibility for the above names child, I give permission for first aid to be administered where considered necessary by a trained first aider, if available, or medical treatment to be administered by a suitably qualified medical practitioner. *
Required
If I cannot be contacted and my child should require emergency hospital treatment, I authorise an adult leader to sign on my behalf any written form of consent required by the hospital. However I understand that every effort will be made to contact me as soon as possible. *
Required
During the time your child will spend with us, photographs may be taken for general church purposes and for this we need your permission. By ticking the box below we will assume you have given your permission for your child's photograph to be taken unless otherwise informed. *
Required
I confirm that the above details are correct to the best of my knowledge.
Signed (Parent/Guardian): *
Your answer
Name printed in full: *
Your answer
Date: *
Your answer
A copy of your responses will be emailed to the address you provided.
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