CB:kids CLUB Consent Form
Please complete this consent form for each child before coming to the club.
We start Friday 23rd September, 6:30pm - 7:45pm.
Carrickfergus Baptist Church, Northlands, Carrickfergus
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Child's Full Name (one child per form please)
 *
Date of Birth
 *
MM
/
DD
/
YYYY
Address
 *
Town
 *
Postcode
 *
Please indicate medical conditions or special needs relevant to your child, any medication being taken and anything else that would be helpful for the leaders toknow about:
Emergency Contacts
Please give details of who to call in an emergency.
Main Contact Name
 *
Main Contact Phone Number *
Main Contact eMail
Secondary Contact Name
Secondary Contact Phone Number
To be read and signed by a parent/guardian
I confirm the above details are correct and I give permission for my child to attend the CB:kids CLUB. 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. In the event of a medical emergency, leaders will endeavour to contact you as soon as possible using the contact telephone numbers given.

I give permission for the leader in charge to hold contact details as a means to communicate if needed.

All information given on this form will be kept securely and only used in connection with the CB:kids CLUB.
We would love to let you see what happens at CB:kids CLUB. I give permission for photographs/video to be taken of my child and be used on the church media online pages unless otherwise informed.

Type your name to give consent to all in the above statement.
 *
Relationship to Child
 *
Thank you
Folow our pages on Facebook & Instagram for frequent updates.
If you have any queries or concerns contact David on 07834239124.
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