Burghead Free Church Youth Club Registration
Email address *
Name of Young Person *
Date of Birth *
Address *
Post Code *
Sex *
Emergency Contact Name *
Emergency Contact Phone Number *
Second Emergency Contact Name *
Second Emergency Contact Phone Number *
Medical information
Are there any medical conditions (i.e. allergies, epilepsy, asthma, diabetes, travel sickness, etc) which we should be aware of?
Family Doctor’s name, address and telephone number *
Any other information you think we should know?
Consent *
You can view our Privacy Notice and other GDPR documents at - https://www.burgheadfreechurch.org/data-protection/
Adult’s Name
A copy of your responses will be emailed to the address you provided.
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