Burghead Free Church Youth Club Registration

Email address *

Name of Young Person *

Date of Birth *

YYYY

Address *

Post Code *

Sex *

Female

Male

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/

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

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

Submit

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