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 *
Your answer
Town *
Your answer
Postcode *
Your answer
Guardian 1 Name *
Your answer
Guardian 1 Relationship to child *
Your answer
Guardian 1 Email
Your answer
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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