Harborne Baptist Church
Junior Church Consent Form
Complete the form below to give permission for your child to join our Junior Church activities
Name of child
First Name
Last Name
Date of birth
-
Day
-
Month
Year
Date
Address
Street Address
Street Address Line 2
City
Post Code
School Name
blanks
School Year
blank
What is your child's first spoken language?
Medical Information
Please provide the details of your child's GP, plus any other relevant information
Name of Doctor
Address
Street Address
Street Address Line 2
City
State / Province
Post Code
Phone Number:
*
Format: 00000000000.
Does your have any allergies (including to medication) or regularly take medication? Please provide details below
Is there any other information we should know about your child?
Emergency Contact 1:
Name
First Name
Last Name
Relationship to child
Address if different from child
Street Address
Street Address Line 2
City
State / Province
Post Code
Phone Number:
*
Format: 00000000000.
Email
example@example.com
Name
First Name
Last Name
Relationship to child
Address if different from child
Street Address
Street Address Line 2
City
State / Province
Post Code
Phone Number:
*
Format: 00000000000.
Email
example@example.com
I give consent for my child to take part in any Junior Church activities both onsite and offsite
Yes
No
I give consent for photos to be taken during sessions and for these to be used on the Harborne Baptist Church YouTube channel and Facebook group
Yes
No
Privacy Policy
I understand that all information will be kept in accordance to our GDPR policy and your information will only be used to be in touch about Junior Church activities
Yes
Signature
Submit
Should be Empty: