Youth Registration Form 2018-19
St Thomas with St Stephen Church, Telford Park
Address: St Stephen's Church, Weir Road, SW12 0NU
Contact: youth@stwss.org.uk

We need this online form completed annually for each young person attending the Youth Ministry of St Thomas with St Stephen. You will only need to compete this form once per child, per academic year. The information you provide will not be given to third parties.

• YOUNG PERSON'S INFORMATION •
Young Person's Full Name *
Your answer
Date of Birth *
Your answer
Gender *
School (in September 2018) *
Your answer
School Year (in September 2018) *
Home Address *
Your answer
Young Person's Mobile Number (if appropriate)
Your answer
Please send general texts with youth information to Young Person (if appropriate)
Young Person's Email Address (if appropriate):
Your answer
Please email Young Person with general youth information (if appropriate)
Please register my son/daughter onto the following programmes... (please tick all relevant boxes) *
Required
• YOUNG PERSON'S MEDICAL & CONSENT INFORMATION •
(If the answer is 'yes' to any of these questions, please give details.)
Does your son/daughter have any special dietary requirements or allergies? *
Your answer
Does your son/daughter have a medical condition/disability/allergy *
Your answer
Does your son/daughter have any additional needs? *
Your answer
Is there any other information which would be helpful for us to know about? *
Your answer
GP Details (Dr's Name, Address, Phone Number) *
Your answer
I consent for my son/daughter to receive appropriate First Aid treatment (e.g. plasters and items found in a First Aid Kit) *
I give permission for my son/daughter to appear in photos and video that can be used for external publicity and promotional purposes (e.g. website/social media). I understand that the identity of my child will be protected in all publication. *
I give permission for my son/daughter to appear in photos and video that can be used for internal publicity and promotional purposes (e.g. youth club, Sunday services). I understand that the identity of my child will be protected in all publication. *
I give permission for my son/daughter to travel home independently. *
• PARENT/CARER INFORMATION •
Name of Parent/Carer A *
Your answer
Home Address of Parent/Carer A (If different to young person's)
Your answer
Mobile Number of Parent/Carer A *
Your answer
Please send general texts with youth information to Parent/Carer A *
Home phone number of Parent/Carer A (optional)
Your answer
Email Address of Parent/Carer A *
Your answer
Please email general youth club information to Parent/Carer A *
Name of Parent/Carer B (optional question)
Your answer
Mobile Number of Parent/Carer B (optional question)
Your answer
Please send general texts with youth information to Parent/Carer B (optional question)
Email Address of Parent/Carer B (optional question)
Your answer
Please email general youth club information to Parent/Carer B (optional question)
Name and phone number of an alternative adult incase of emergencies (not a parent/carer) *
Your answer
• FINAL CONSENT •
I give consent for my son/daughter to attend St Thomas with St Stephen's Youth Ministry *
I consent to the details provided being added to the St Thomas with St Stephen data-base for communication purposes. I understand that the information provided will not be given to third parties. For full details about how we use your data, please visit stwss.org.uk/privacy *
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