Auldhouse Youth Registration & Consent

1
For which event(s) are you registering and giving consent?* This field is required.Make as many selections as you'd like
Unplugged Youth Club (P6-S3), Tuesdays 6:45-7:45pm
After School Club (P6-S3), Thursdays 3:15-4:15pm
Sunday Groups (P6-S6), Sundays various times
I'm not sure
Auldhouse Young Leader (S4-S6), by invite only
2
Young Person's Name* This field is required.
First Name
Last Name
3
Date of Birth* This field is required.
Day
Month
Year
4
Gender* This field is required.
Please Select
Please Select
Male
Female
I'd rather not choose
5
Current School Year* This field is required.Please select the school year your young person is currently in. If it is the summer holidays now, select the school year your young person is starting after the summer.
P5
P6
P7
S1
S2
S3
S4
S5
S6
Select a school year
6
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
7
Young Person's Email Address (Optional)Please note that this is NOT contact information for Parent/Guardians but for young people
example@example.com
8
Young Person's Mobile Number (Optional)Please note that this is NOT contact information for Parent/Guardians but for young people
Please enter your young person's mobile number
9
Parent/Guardian's Details* This field is required.Please enter your full name
First Name
Last Name
10
Parent/Guardian's Email Address* This field is required.Please enter the best email address to contact you with general enquiries and information
example@example.com
11
Parent/Guardian's Mobile Number* This field is required.Please enter the best mobile number to contact you with general enquiries and information. Note: Please select "Contact me by Text Message" at the next step, if you would like to be kept up-to-date with details regarding Auldhouse Youth events.
Please enter your mobile number
12
I give consent for Auldhouse Community Church Youth Group to* This field is required.Tick the appropriate boxes
Contact my young person by Text Message
Contact my young person by E-mail
Contact me by Text Message
Contact me by E-mail
Take pictures/video footage of my young person for use on our Social Media Channels and Website
13
Emergency Contact Name* This field is required.Please provide information below which we can use to contact you in the event of an emergency relating to your young person
First Name
Last Name
14
Emergency Contact Mobile Number* This field is required.Please provide information below which we can use to contact you in the event of an emergency relating to your young person
Please enter a number we can use to contact you in case of an emergency
15
Medical Information* This field is required.Are there any medical conditions (i.e. allergies, epilepsy, asthma, diabetes, travel sickness etc.) which we should be aware of?
Enter "None" if not applicable
16
Medical Information* This field is required.Please give details of any special dietary needs we should be aware of (e.g. food allergies)
Enter "None" if not applicable
17
Parent/Guardian Consent* This field is required.I hereby grant Auldhouse Community Church Youth Group consent to process my personal data for the purposes setout above. I agree to my young person participating in Auldhouse Youth events and the activities run by the team. I understand that every care will be taken to ensure the health, safety and welfare of my child. I realise that in the event of my child's behaviour adversely affecting the safety of the activity, the organisers reserve the right to ask me to collect my child from the activity early.
I have read and agree to the above statement of consent
18
Parent/Guardian Consent - Name* This field is required. Please enter your First and Last name
First Name
Last Name
19
Parent/Guardian Consent - Signature* This field is required.Please sign inside the box
Clear
20
Parent/Guardian Consent - Today's Date* This field is required.Please enter today's date
Today's date
Day
Month
Year
Should be Empty: