If you are interested in being part of Summer Groups, please fill out the details below.

For young people under 18, we ask that a parent/guardian fill out the form below.

Michael will arrange a time and location. If you have preferences of who is in your group of 8 - please let him know. 07885235497

As a parent/guardian, by filling in this form you are giving permission for your young person to attend a summer group.

Please sign up by July 1.
Child's Full Name : *
D.O.B *
Parent/ Guardian Name: *
Address *
Contact Number: *
Email: *
Emergency Contact 2: ( Name & Number ) *
Medical Conditions/Emergency Details
In the event of illness or accident, having parental responsibility for the above named child, I give permission for first aid to be administered where considered necessary by a first aider, If available, or medical treatment to be administered by a suitably qualified medical practitioner.

In the event of a medical emergency, leaders will endeavour to contact you as soon as possible using the contact telephone numbers given.

I will inform the leaders of any changes to my child's health, medication or needs and also of any changes to our address or any of the phone numbers given above.
Please indicate medical conditions, additional needs, allergies or dietary requirements relevant to your child, any medication being taken and anything else that would be helpful for the leaders to know about: *
During the time your child will spends with us, photographs may be taken for general church purposes such as the BPC Youth Instagram Page. Do you give permission for your child's picture to be taken and used? *
Please note, social distancing will be adhered to. Please remind your child of these expectations prior to any time together.
GDPR Consent
Data collected on this form will be used for the administration of Bloomfield Presbyterian Church only and for ensuring the safety and well-being of young people in the group.

This information will only be used for the stated purpose and will not be shared with any other organisations.

All personal data collected from this form will be downloaded and stored safely under password-protection.

I hereby give permission for my son/daughter to take part in BPC Youth Summer Groups.

If you have a query about how your personal data is used by the Bloomfield Presbyterian Church please contact Michael. Consent may be withdrawn at any time by contacting Michael on 07885235497
By clicking the box below I agree with the above GDPR guidance. *
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