Anything written on this form will be held in confidence and only used for Gortmerron Baptist Youth Club. The leaders need to know these details in order to meet the specific needs of your child.

Child/children details

Child’s Name (required)

Child’s D.O.B. (required)

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Child #2's Name

Child#2's D.O.B.

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Child #3's Name

Child’s #3's D.O.B.

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Child #4's Name

Child’s #4's D.O.B.

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Home Address (required)

Postcode (required)

Emergency Contact Numbers

As deemed appropriate by leaders, emergency contact details provided may very occasionally also be used for purposes such as unexpected cancellations of events.

Phone numbers (including code) where I (parent/guardian) can be contacted in an emergency:

Home Phone (required)

Mobile Phone (required)

If unavailable contact:

Secondary Contact Name (required)

Secondary Contact Phone: (required)

Secondary Contact Relationship to Child: (required)

Medical

Has your child any medical condition of which you feel we should be aware (e.g. asthma, epilepsy, diabetes, allergies)? If so, please give details below: (If sending multiple children please name applicable child(ren) below)

Consent

I give permission for my child(ren) to attend Gortmerron Baptist Youth Club and to participate in all its activities. (consent required to attend)
---Consent to child(ren)'s attendance

I give permission for my child(ren) to travel in transport that has been organised by the Youth Club.
---Consent to transportDo not consent to transport

I give permission for permission for photographs to be taken of my child(ren) at events.
---Consent to photosDo not consent to photos

I also authorise the leader-in-charge to give, on my behalf if I cannot be contacted, consent for any urgent medical attention. However, I understand that every effort will be made to contact me as soon as possible. (consent required to attend)
---Consent to urgent medical attention

Please Note

The youth club operates a NO MOBILE PHONE policy, phones will be removed from the child until the end of the club & returned to the parent/guardian when picking up.

Inappropriate behaviour will NOT be tolerated at youth club. If bad behaviour persists then parent/guardian will be spoken to & if necessary the child could be banned from youth club.

Digital signature (required)

Please type your own name (Parent/Guardian) below in place of a signature.