Bible Explorers 
Registration 2023/24
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Email *
Child's first name *
Child's surname *
Date of birth
*
Current school year *
Home address *
Contact details
Phone number(s) where I can be contacted in an emergency:
First contact name *
Relationship to child *
Home telephone number  *
Mobile number  *
Second contact name *
Relationship to child *
Second contact telephone number  *
Medical History
Doctor's name *
Doctor's telephone number *
Please give details of any known conditions, allergies etc (asthma, diabetes, epilepsy) and any medication taken:
Please give details of any other special needs, requirements or conditions that would be helpful for leaders to know:
Consent (tick below to complete form)
MEDICAL TREATMENT
In the event of illness/accident, having parental responsibility for the above-named 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.  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 for the above unless otherwise informed.

PHOTOGRAPHS, VIDEOS AND WEBSITES
During the time your child will spend with us, photographs and/or video footage may be taken by leaders for general church purposes, including social media, and for this we need your permission.  On ticking the box below, we will assume you have given permission for your child's photo to be taken unless otherwise informed.  We may also contact you via email/WhatsApp with information relating to Bible Explorers activities. 
As a Parent/Guardian, by ticking the box below, I confirm that all the above details are correct to the best of my knowledge and that I give permission for my child to take part in Bible Explorers at Larne Mission Hall *
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