Registration form
C.O.S.Y. Youth Club - Chilham Parish Council - www.chilhamparishcouncil.gov.uk
Please complete this form in advance of your child's first attendance
Information provided will be held in accordance with Chilham Parish Council's GDPR policy and procedures. Where a member leaves C.O.S.Y., the data will be deleted. In the event of non-attendance for 6 weeks without contact from a parent, data will also be deleted - a fresh registration form will need to be completed on return to the Club.
Name of child
*
First Name
Last Name
Age
*
Years
Date of birth
*
-
Day
-
Month
Year
Date
Address
*
Street Address
Street Address Line 2
City
County
Post code
Phone Number - land line
*
Please enter a valid phone number.
Format: 00000-000000.
Phone Number - mobile
*
Please enter a valid phone number.
Format: 00000-000000.
Name of Doctor
*
Doctor's surgery
*
Does your child have any allergies or take medication?
No
Yes
If answer is YES, please give details of allergy and medications
Does your child have any medical conditions that we should be aware of?
No
Yes
If answer is YES, please give brief details of condition(s)
EMERGENCY CONTACT DETAILS
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
County
Post code
Emergency phone number - landline
*
Please enter a valid phone number.
Format: 00000-000000.
Emergency phone Number - mobile
*
Please enter a valid phone number.
Format: 00000-000000.
I give my consent for Chilham Youth Club to administer first aid to my child and/or notify the emergency services in the event of an accident/illness.
*
Yes
I will update Chilham Youth Club with any additional information or any changes regarding my child’s status or well-being.
*
Yes
I give my permission for my child's photograph to be taken and used for promotion in social media for the benefit of C.O.S.Y.
*
Yes
No
I undertake that my child will adhere to the rules and regulations of C.O.S.Y. at all times. Any inappropriate behaviours will be dealt with in line with the club’s policies and may result in my child’s membership being withdrawn.
*
Yes
Please choose a PASSWORD to be used in the event of an emergency or non-parent collection
*
Enter password - remember to keep a note of it!
Type name of parent completing this form
First Name
Last Name
Date of completion of form
*
-
Day
-
Month
Year
Email (for emergency and urgent contact)
*
example@example.com
I consent to use of this e-mail address for routine mailings about C.O.S.Y. youth club
Yes
No
Email
example@example.com
Submit
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