Burghead Free Church Youth Club Registration
Email address *
Name of Young Person *
Your answer
Date of Birth *
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DD
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YYYY
Address *
Your answer
Post Code *
Your answer
Sex *
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/
Required
Adult’s Name
Your answer
A copy of your responses will be emailed to the address you provided.
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