Bethel Evangelical Church, Nelson                                        - Registration Form - Adventure Club 2026 
We are very pleased that you have chosen to allow your son/daughter to attend a child/youth activity at Bethel Evangelical Church, Nelson.    This form will be used for all child/youth day or evening activities (i.e. Adventure Club / Bethel Youth Club)

In order to support  your child we will require basic information such as contact details, basic medical/nutrition information, and essential pick-up requirements.

This completed data-protected form will be accessed by a small number of our church workers (on a need-to-know-basis only) all of whom will have had a DBS record check. 

Please complete the areas  below with as much information as you can provide to ensure your child has a successful time with us. 

If you have any questions please contact Esther Chaplin: 07951 679580
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Name of Child - 
       Last name
       First name
 *
Date of Birth (Day, Month, Year) *
1st CONTACT - Name of custodial Parent(s) / Guardian
Include:
              Name
              Address
              Phone number
 *
2nd CONTACT  - (parent / relative / friend etc) 
Include:
              Name
              Address
              Phone number
 *
Other emergency contact (if required) 
Include:
              Name
              Address
              Phone number
Names of those authorised to pick up your child at the end of the activity?
Please list all names and relationship. 
 *
Please list the name of anyone specific who MUST
NOT have access to your child. 
Please list all names and relationship  - or N/A

 *
Do you authorize your child to leave our DAYTIME activity independently (i.e. alone, without an adult, with or without a friend) *
Do you authorize your child to leave our EVENING  activity independently (i.e. alone, without an adult, with or without a friend) *
Please provide any nutritional information  which would be helpful for us to know while your child is participating in our activity (e.g. food allergies or specific diet etc )
Please type NONE if the above does not apply.
 *
Please provide medical information which is important for us to know while your child is participating in our activity (e.g. diabetes, epilepsy, allergies etc).
Please indicate any meds that your child will bring with them (e.g. Epipen).
Please type NONE if the above does not apply.
 *
Please indicate whether you allow your child's photograph on Bethel's social media page(s) (e.g. Facebook) *
Please use this space to provide us with any other information that you believe is important for us to know.
Please type NONE if the above does not apply. 
 *
I am the Parent / Legal Guardian of the child named at the top of this form.

The information I have provided  is correct and is my authorisation for the named child to participate and for other areas mentioned in this form.  

I will contact you if I need to change any of the information at any point and request that the information be deleted. I understand I will be requested to complete a new form with updated information.  

Please type the name of the authorised person completing this form below.   This will be regarded as your signature.  
 *
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