Amazing Circus Holiday Club Registration
Sign up children P1-P7 for this years Holiday Bible Club at Burghead Free Church.
Questions? - contact us at peter@burgheadfreechurch.org
Email address *
CHILD’S DETAILS
Name, gender, age, health etc.
Child’s First Name *
Your answer
Child’s Surname *
Your answer
Child’s Address *
Your answer
Child’s Gender *
School Year (as of Aug 2019) *
Child’s School *
Your answer
GP Name & Address *
Your answer
Medical conditions to be aware of?
Allergies, medication to be taken, conditions like epilepsy etc.
Your answer
Additional needs we should be aware of?
E.g. Autism.
Your answer
PARENT/CARER’S DETAILS
Parent/Carer’s Name *
Your answer
Address (if different from Child’s)
Leave blank if same as child.
Your answer
Home Phone Number
Your answer
Mobile Phone Number *
Your answer
EMERGENCY CONTACT DETAILS
These should be the details of someone DIFFERENT TO THE PARENT/CARER LISTED ABOVE
Emergency Contact Name *
Your answer
Emergency Contact Address *
Your answer
Emergency Contact Phone Number *
Your answer
PERMISSIONS
Attendance, contact, publicity etc.
Data Storage (GDPR) *
The government have recently introduced new laws around data protection. We would very much like to keep in touch with you. By completing this form, you consent to Burghead Free Church of Scotland processing your personal data, provided by you on this form, for the purposes of including it in our contacts directory (Not a public document). We would also like to keep in touch with you to inform you about church news, events and activities. You can view our privacy statement (and other GDPR related documents) at burgheadfreechurch.org/data
I consent to being contacted by Burghead Free Church by: *
Required
Photos Consent
PHOTOS ARE TAKEN AT THIS EVENT FOR FUTURE PUBLICITY PURPOSES. ARE YOU WILLING FOR US TO INCLUDE YOUR CHILD IN ANY PHOTOS?
Attendance Consent
I GIVE PERMISSION FOR MY SON/DAUGHTER TO ATTEND LIFE BUILDER HOLIDAY CLUB AND TAKE PART IN ALL ITS ACTIVITIES. IN THE UNLIKELY EVENT OF AN ACCIDENT I GIVE PERMISSION FOR ANY NECESSARY MEDICAL TREATMENT TO BE GIVEN BY THE NOMINATED FIRST AIDER. IN AN EMERGENCY I AM WILLING FOR MY SON/DAUGHTER TO RECEIVE HOSPITAL TREATMENT INCLUDING AN ANAESTHETIC. I UNDERSTAND EVERY EFFORT WILL BE MADE TO CONTACT ME.*
Submit
Never submit passwords through Google Forms.
This form was created inside of Burghead Free Church. Report Abuse - Terms of Service