KidShape Registrations
Registration form for KidShape (Sundays 11:00am - 12:30pm during Sunday Morning Services) at Excel Church. This programme is for 3-11yr olds.
Forenames of Child *
Your answer
Surname of Child *
Your answer
Child's Date of Birth *
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Child's Address *
Your answer
Postcode *
Your answer
Child's School
Your answer
Parent's Email address
This will help to keep you informed about what is going on at Excel Church. We will never pass your information on to any third party.
Your answer
Details of any regular medication, medical problem (eg - asthma, epilepsy, diabetes, allergies, dietary needs etc.) or disability which may affect normal activity
Your answer
GP name and Telephone number
Your answer
Date of last anti-tetanus if known
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DD
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YYYY
Who does your child live with? *
NAMES and RELATIONSHIP to the child of any parents/carers.
Your answer
Emergency Contact Numbers *
Please provide names and numbers
Your answer
Additional Emergency Contact Number (recommended)
This could be a grandparent etc.
Your answer
If you do not have parental responsibility (e.g. you are a foster carer/grandparent etc) please give details of those with parental responsibility
Please give name, address and telephone number
Your answer
Consent *
I give permission for my son/daughter named above to take part in the normal activities of this group. I understand that separate permission will be sought for certain activities, including swimming, and outings lasting longer than the normal meeting times of the group. I understand that while involved he/she will be under the control and care of the group leader and/or other leaders approved by the church leadership and that, while the staff in charge of the group will take all reasonable care of the young people, they cannot necessarily be held responsible for any loss, damage or injury suffered by my son/daughter during, or as a result of, the activity. I understand that my child will receive medication as instructed.  I also understand that if my son or daughter becomes ill, then every effort will be made to inform me.  If I am not contactable, then my child will be given medical or dental treatment as considered necessary further to any medical advice being sought. I understand that KidShape will take photos which may be used for promotional purposes on the web site, social media, printed materials and local press. I understand that it is my responsibility to inform Kidshape if I prefer my child's photo not to be used. We will not pass on or sell any of your data to any third party.
Required
Your Name *
The name of the parent/carer completing this form
Your answer
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