Youth Club 2021/22
Saturday Nights
7:15 to 9:15pm
Young Person's FULL name: *
Date of Birth:
MM
/
DD
/
YYYY
Address and Postcode:
School Year as of September 2021:
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School Child attends:
Parents email address:
Emergency Contact 1 (Full name, number and relation to child): *
Emergency Contact 2 (Full name, number and relation to child): *
Please list any medical conditions, additional needs (SEN), allergies or any other requirements which may affect your child whilst attending the organisation (Masks must be worn by everyone unless exempt - please also note below if your son/daughter is exempt from wearing a mask): *
In the event of illness or accident, having parental responsibility, I give consent for a Designated Leader to administer First Aid and/or my child’s prescribed medication as a First Aid measure only.
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Photographs may be taken only by a Designated Leader and used for general church platforms including social media and website. Once we no longer need images for publicity purposes they will be deleted. Please check below to give consent for us to photograph your child and use images as described above.
I agree that I will not send my son/daughter if they or a member of their household are unwell/displaying COVID-19 symptoms and acknowledge that they are responsible for following all safety measures put in place by leaders.
I confirm that the above details are correct to the best of my knowledge and will inform the Leaders of any changes.
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