Summer Club 2022 Registration Form

Which club do you wish your child to attend? *

Monday-Friday evenings, 6.15pm-8.00pm (for those entering p5-s2) Thursday and Friday mornings, 10am-12noon (for those entering p2-p4)

Name of child *

Date of birth *

dd/mm/yy

Class (Aug 2022) *

Address *

Any additional needs/ medical conditions/ allergies of which we should be aware?

Name of parent/ carer *

Phone number of parent/ carer *

E-mail address of parent/ carer

Alternative contact name (in case of emergency) *

Alternative contact number *

I give permission for my child to walk home at the end (p5+)

yes no, I will ensure my child is picked up.

I give permission for photos to be taken and displayed in the church, website or Facebook page and YouTube channel.

yes no displayed within the church but not online

I give permission for Kinmylies Church to contact me about future events. (Data will be stored securely and not passed on to any other parties. Our full data protection policy is available on the church website: www.kinmylies.co.uk/dataprotection.htm)

yes no

I give permission for my child to take part in activities as outlined above. In an emergency and/or I cannot be contacted, I am willing for my child to receive necessary hospital or dental treatment including an anaesthetic.

Signature

Clear