Kids Kirk God's Zoo Registration Form 2022

Kids Kirk - God's Zoo

Chalmers Memorial Church, Port Seton
Child's Information
Child's Name*

First NameLast Name
Child's Birth Date*

DayMonthYear
Current Year (2022)*
Does your child have any additional support needs? How can we support them?
Does your child have any medical conditions or food allergies we need to be aware of?
Parent/Guardian Details
Parent/Legal Guardian Name*

First NameLast Name
Mobile Phone Number*
Email
example@example.com
Address*

Street Address

Street Address Line 2

TownCounty

Post Code
Who will collect your child?*

First NameLast Name
Emergency Contact 1 (other than parent/guardian listed above)*

First NameLast Name
Relationship
Mobile Phone Number*
Emergency Contact 2 (other than parent/guardian listed above)

First NameLast Name
Relationship
Mobile Phone Number
I AgreeI Do Not Agree
Within the Church HallOn FacebookOn Church websiteI Do Not Agree
I give permission for the above named child to take part in all activities at Kids Kirk. In the unlikely event of illness or accident, I give permission for any necessary medical treatment to be given by the nominated first-aider. In an emergency and if I can’t be contacted, I am willing for my child to receive hospital treatment, including anaesthetic if necessary. I understand that every effort will be made to contact me as soon as possible. I understand that all due care, supervision and precautions will be taken at all times but that ultimately my son/daughter is responsible for his/her own actions and club leaders cannot necessarily be held responsible for any loss, damage or injury suffered by my child during or as a result of, the activity*

I Agree
I Agree
I Agree
Should be Empty:

Kids Kirk - God's Zoo

Child's Information

Parent/Guardian Details