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Youth Registration Form

This form is to be completed in full by a parent or carer only, and covers all regular attendance at any of our church groups and events for youth during the academic year 2019/20.


Details of young person:

Young person's full name:
   
Gender: Male
Female
   
Address:
 
 
Town:
County:
Postcode:
 
Home telephone:
   
Do you give permission for your child to receive emails and text messages from staff or volunteers from church?
(All methods of communication are in compliance with our Safe From Harm Policy)
Mobile number of young person:
Email address of young person:
   
Date of birth:
School:
School year:
Notifiable medical conditions:
Include allergies, details of medication and any medical details we need to know, e.g. Epilepsy, ADHD, Ashtma etc
 

Parent / carer contact details:

Title:
Parent's full name:
Mobile number:
Email address:
 

Emergency contact details:


Parent / carer details given above will be used as the first emergency contact, however please supply a second contact for emergencies
Second Emergency Contact Name:
Phone number:
Relationship to young person:

Media and electronic communication:

The church may also take photographs / video at groups which may include your child. They may be used to publicise further events or in church publications.  Any pictures or video taken will be used sensitively and in compliance with our Safe From Harm Policy, which is available to read here.
 
Do you give permission for your child to appear in these photographs / videos and for these to be used by the church?
   
Do you also give permission for the photographs / videos to be used on the church website and social media sites?
 

Declaration:

I give permission for the young person named to take part in the normal activities of the youth groups. I understand that separate permission will be sought for certain activities, including off site trips operating outside the usual group times.

I understand that while involved he / she will be under the control and care of the group leader, and / or other adults approved by the church leadership and that, while the staff in charge of the group will take all reasonable care of the children, they cannot necessarily be held responsible for any loss, damage or injury suffered by him / her duirng or as a result of, the activity.

I confirm that by clicking 'Send' I am submitting full and accurate information, that I am the parent / carer of the young person named, and that I give permission for the young person named to take part in the normal activities of the youth groups.
 
In an emergency and / or if I am not contactable, I am willing for him / her to receive necessary hospital or dental treatment including an anaesthetic.