67th Company BB Contact Information Form
Child's Christian Name
Your answer
Child's Surname
Your answer
Child's Date Of Birth
MM
/
DD
/
YYYY
Street Address
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Town
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Postcode
Your answer
Guardian 1 Name
Your answer
Guardian 1 Relationship to child
Your answer
Guardian 1 Email
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Guardian 1 Telephone Number
Your answer
Guardian 2 Name
Your answer
Guardian 2 Relationship to child
Your answer
Guardian 2 Email
Your answer
Guardian 2 Telephone Number
Your answer
GP Name, Surgery and Telephone Number
Your answer
Details of any known medical conditions, allergies etc
Required
Details of any medication taken
Your answer
** Details of any other medical conditions 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 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.
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.
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