REGISTRATION & CONSENT FORM St Matthew's "Circus Holiday Club" 17-21 February 2020
St Matthew's Church • 205 Southcote Lane • Reading • RG30 3AX
0118 954 7964 • www.st-matts.org.uk
Email address *
CHILD'S NAME / SURNAME *
Your answer
Which days will your child come?
ADDRESS *
Your answer
DATE OF BIRTH *
MM
/
DD
/
YYYY
SCHOOL *
Your answer
SCHOOL YEAR GROUP *
Your answer
PARENT / GUARDIAN DETAILS: Name / Surname *
Your answer
Home / Mobile (provide at least 2 numbers) *
Your answer
Address (if different from child)
Your answer
ALTERNATIVE CONTACT if Parent / Guardian is unavailable (provide 2 different contacts)
Contact 1: Name / Mobile Phone / Address *
Your answer
Contact 2: Name / Mobile Phone / Address *
Your answer
While your child is in our care, it is helpful for us to know of any ALLERGIES, medical conditions or disabilities.
Are there any social or behavioural issues or anything else you would like us to know? *
Your answer
Details of any medication (ensure it's clearly labelled with your child's name and hand it to one of the Holiday Club leaders) *
Your answer
Details of dietary restrictions *
Your answer
Family Doctor: Name, Address and Telephone *
Your answer
Any other information concerning your child that the Holiday Club organisers should know *
Your answer
COLLECTION FROM ST MATTHEW'S: Please tick A or B only *
Required
I agree to EMERGENCY TREATMENT if necessary *
Required
* The medical profession takes the view that a parent's consent to medical treatment cannot be delegated. Medical consent forms have no legal status and a doctor has the right to insist parental consent is given before treating a child. We have found, however, that medical staff find this type of general consent helpful.
CHANGES of circumstances or information *
PHOTOGRAPHS and short videos of activities including your child may be taken for promotional purposes.
I give permission for pictures of my child to be taken: *
We operate a TEXT MESSAGING service to parents informing you of upcoming events relevant to your child
I am happy to receive text messages about future events *
DATA PROTECTION NOTICE
WE WILL NOT SHARE YOUR DETAILS WITH ANYONE. You can find our Privacy Policy on our website, and displayed on the wall of the church foyer. If you need a copy, please contact the Church Office.
I consent to the processing of my personal data by St Matthew's Church in compliance with the General Data Protection Regulation (the “GDPR”). I understand that I can withdraw my consent at any time. *
Date *
MM
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DD
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YYYY
Typed Signature of parent / guardian *
Your answer
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