Registration Form
Ballyclare EPC Holiday Bible Club 2023
Child's Name
*
First Name
Last Name
Primary School Class (in Sept 2023)
*
Please Select
P 1
P 2
P 3
P 4
P 5
P 6
P 7
The class your child is going into
Child's Date of Birth
*
-
Day
-
Month
Year
Date
Child's Age on 1st September 2023
*
Please Select
4
5
6
7
8
9
10
11
Emergency Phone Number
*
Please enter a valid phone number.
Format: (000) 0000-0000.
2nd Contact Number
Please enter a valid phone number.
Format: (000) 0000-0000.
Address
*
Street Address
Street Address Line 2
Town
State / Province
Post Code
Name of Parent/Guardian
*
First Name
Last Name
Contact Email
*
example@example.com
Any known Allergies, conditions or medication taken:
*
Details of any other additional needs, requirements, or directions that would be helpful for leaders to know:
*
Do you require transport?
*
Yes
No
Data consent declaration: The data collected here is for the sole use of Ballyclare EPC and will not be shared by us with any third party. In line with the Church GDPR policy these records will be kept securely for 6 years after which point the information will be destroyed.
*
I agree to the information supplied, by me, being handled in this manner.
During the course of the week, photos and videos may be taken for Church use.
*
I give permission for my child to be photographed
I request my child is not photographed
Medical treatment: In the event of illness or accident, having parental consent for the above named child, I give permission for first aid to be administered where considered necessary. If I cannot be contacted and my child should require emergency hospital treatment, I authorise an adult leader to sign on my behalf any written form of consent required by the hospital. However, I understand that every effort will be made to contact me as soon as possible.
*
I give permission for my child to receive medical treatment if needed
I do not give permission for my child to receive medical treatment
Submit
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