RBF Outreach Registration Form

Thank you for applying for your child to take part in an RBF Outreach project. Where you are applying for multiple siblings, you must complete the entire form for each child.

Due to recently announced National Restrictions for England during November/December 2020, we are not currently able to accept registrations for the following groups:

- The Vault (Waltham Abbey)

- Journey to Bethlehem (Standon & Puckeridge Community Centre)

- Journey to Bethlehem (All Saints Little Munden)

We can also confirm that the following groups will be happening 'online only' for the duration of the National Restrictions beginning from Thursday 5th November:

- The Hub (Brentwood Baptist)
Please select which RBF Outreach Project you are looking to apply for *
If you cannot see the Project you are looking for please contact office@rbf.org.uk
Information about your Child
Name of Child *

First Name Last Name
Address *

Street Address

Street Address Line 2

City County

Postcode
Date of Birth

Day Month Year
Date
Medical Conditions (including Allegies) *
Please type 'None Known' if your child does not have any diagnosed medical conditions
Dietary Preferences (likes/dislikes rather than allergies/intolerances) *
Please type 'None Known' if there are no foods your child does not like to eat.
Additional Needs (including learning/physical disabilities) *
Please type 'None Known' if your child does not have any additional learning needs or disabilites
School Attended *
as at September 2020
School Year Group *
as at September 2020

Information About Parents/Carers
Primary Parent/Carer Name *

First Name Last Name
Relationship to the Child *
Primary Parent/Carer Email *
example@example.com
Primary Parent/Carer Phone Number *
Primary Parent/Carer Address (if different from child)

Street Address

Street Address Line 2

City County

Postcode
Name of Emergency Contact Person (must be different from Primary Parent/Carer) *

First Name Last Name
Relationship to the Child
Emergency Contact Phone Number (must be different from Primary Parent/Carer) *

Declarations

Please note that you can rescind your permission for any of these at any time by contacting office@rbf.org.uk
COVID Security *

I agree that I will not send my child to the project (and will contact RBF immediately) if they, a member of their household or their social bubble displays any symptoms of COVID19 I agree that I will inform RBF if our family has been instructed to isolate by NHS Track & Trace scheme or another medical professional I confirm as a parent/carer of the above named child, I give permission for them to take part in RBF virtual groups/contacts with Red Balloon Foundation staff and volunteers should the group not be able to run in person. I consent for them being used for the purposes outlined and to keep me updated about virtual group availability. I understand I can revoke any of these consents at any time by contacting office@rbf.org.uk
Images/Video Footage

We love to share what we are doing at RBF with others; if you are happy for photos or video of your child to be used on our website, social media and printed marketing please tick here.
Personal Data *

At RBF we follow all government guidance on data protection. We will share data about you and your child with local authority bodies in cases where there is a concern about safety, and if the project you are registering for is delivered in partnership with another agency (this will be identified on our website) we will also share your data with them. Please tick to confirm that you have read and agree for RBF to handle your data this way, if you would like to see our full privacy policy or have any questions, contact office@rbf.org.uk
Contact

If you are happy to be contacted by RBF about our other projects or those of our partners (your details will not be shared with them) by EMAIL tick here If you are happy to be contacted by RBF about our projects or those of our partners (your details will not be shared with them) by PHONE tick here If you are happy to be contacted by RBF about our projects or those of our partners (your details will not be shared with them) by TEXT MESSAGE ALERT tick here
Is there anything else you would like to let us know?
Should be Empty:

Information about your Child

Information About Parents/Carers

Declarations