FISHERWICK PRESBYTERIAN CHURCH HOLIDAY BIBLE CLUB 19-25 AUGUST 2019 REGISTRATION AND CONSENT FORM
Please use a separate form for each child.
Child's Name (required)
FemaleMale
Date of Birth (required)
Child's Age (required)
Class your child will be entering in September 2019. P1P2P3P4P5P6P7
Parent/Carer's Name (required)
Your address
Postcode
Your Email (required)
Contact numbers: Home: Work: Mobile:
Emergency contact names and phone numbers (if parent/carer above not available): Name: Phone: Relationship to child: OR Name: Phone: Relationship to child:
Child's GP details Name of GP: Phone number: GP address
Details of any known conditions, allergies etc (for example, asthma, diabetes, epilepsy) and any medication being taken:
Any other special needs, requirements or directions that would be helpful for the leaders to know about.
I give permission for photographs and video to be taken within the club for use at the club and future events: YesNo
I give permission for my child's name and details to be entered in the church database: YesNo
I am happy to be contacted by email about relevant club events and other related events organised by the church: YesNo
How did you find out about the Fisherwick Holiday Bible Club?
DECLARATION OF CONSENT
I confirm that the above details are complete and correct to the best of my knowledge. In the unlikely event of illness or accident, I give permission for appropriate first aid to be given. In an emergency, and if I cannot be contacted, I am willing for my child to be given hospital treatment, including anaesthetic if necessary. I understand that every effort will be made to contact me as soon as possible.
Your Name: (Parent/Carer)
Your email address: