Burghead Free Church Youth Club Registration

Email address *

Name of Young Person *

Your answer

Date of Birth *

YYYY

Address *

Your answer

Post Code *

Your answer

Sex *

Female

Male

Emergency Contact Name *

Your answer

Emergency Contact Phone Number *

Your answer

Second Emergency Contact Name *

Your answer

Second Emergency Contact Phone Number *

Your answer

Medical information

Are there any medical conditions (i.e. allergies, epilepsy, asthma, diabetes, travel sickness, etc) which we should be aware of?

Your answer

Family Doctor’s name, address and telephone number *

Your answer

Any other information you think we should know?

Your answer

Consent *

You can view our Privacy Notice and other GDPR documents at - https://www.burgheadfreechurch.org/data-protection/

I give consent for my child to attend Burghead Free Church Youth Club

I consent to being contacted by ‘Phone

I consent to being contacted by email

I consent to being contacted by post

I consent to photographs and short videos including my child to be used for publicity (inc. on social media)

Required

Adult’s Name

Your answer

A copy of your responses will be emailed to the address you provided.

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