REGISTRATION & CONSENT FORM
*FREE EVENT* - Bible Stories - Crafts - Lunches - Games - Sweets- Prizes - Cross-Community
Who? = Children can be dropped off if they are aged 4-12. Care givers are welcome to stay.
When? = Derry: Thursday, 13th & Friday, 14th, June, 3:30pm-5:30pm  |  Buncrana: Monday, 24th-Wednesday 26th, June 3:30pm - 5:30pm.
Where? Venue: (Derry) Carlisle Road Methodist Hall,  BT48 6JJ   |   (Buncrana) Buncrana Youth Club, Castle Avenue,
Contact: James Wilson on +447963601115 - info @derryfellowship.ie
Derry Baptist Fellowship have a stringent child safeguarding policy in place to protect the children and the volunteers.
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Which location/dates are you registering for? *
Required
Child’s First Name *
Child’s Surname *
DOB *
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Address *
Give details of any allergies or medical conditions to be aware while they are in our care.
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Parent/Guardian Information
First Name & Surname  *
Relationship with child *
Phone number *
Email *
Will you be attending with your child?  *
Required
Pictures/video are sometimes taken. Can your child be included in this? *
AGREEMENT 

1. I allow my child to participate in this Holiday Club. 

   

2. I understand that in the event of any illness or accident, every effort will be made to contact me. However, if this is not possible, I authorise the leader in charge to sign on my behalf any written form of consent required by the medical authorities. 

 

3. I confirm that all information in this form is accurate and true to the best of my knowledge.

 

4. Parents/Carers are very welcome to stay for this family friendly event. If they are not staying with child, they are asked to please come inside to drop off and collect their children. 

5. PRIVACY & DATA PROTECTION CONSENT

Your privacy is important to us, and we want to ensure that your data is held in compliance with EU GDPR regulations as of May 25th 2018. As a result of this new legislation, we need your consent on how we contact you. Your data will not be shared with a third party for any reason.

By signing this form you are confirming that you are consenting to Derry Baptist holding and processing your personal data to be used for Derry Baptist purposes only.


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Parent/Guardian Signature *
Date Signed  *
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