Youth Week 2023

Youth Week 2023

Tuesday 8th - Thursday 10th August, 7:30pm at Killead Presbyterian Church
Parent's Name*

First NameLast Name
Parent's Phone Number*
Please enter a valid phone number.
Emergency Contact*

First NameLast Name
Emergency Contact's Number*
Please enter a valid phone number.
Parent's Email Address*
example@example.com
Address*

Street Address

Street Address Line 2

TownCounty

Post Code
Child's Name*

First NameLast Name
Child's Date of Birth*

DayMonthYear
Date
Class in school they are entering in September*

Year 8Year 9Year 10Year 11Year 12Year 13Year 14
Dates Attending*

Tuesday 8th AugustWednesday 9th AugustThursday 10th August
Child's Medical Information - Please indicate medical conditions, special needs, allergies or dietary requirements relevant to your child, any medication being taken and anything else that would be helpful for the leaders to know about:*
Permission (Website) - I give permission for the above named child's photograph to be taken and uploaded to the church's website.*

YesNo
Permission (Facebook) - I give permission for the above named child's photograph to be taken and uploaded to the church's Facebook page.*

YesNo
Permission (Emergency First Aid) - In the event of illness or accident, having parental responsibility for the above named child, I give permission for first aid to be administered where considered necessary by a first aider, if available, or medical treatment to be administered by a suitably qualified medical practitioner. In the event of a medical emergency, leaders will endeavour to contact you as soon as possible using the contact telephone number given.*

YesNo

BBQ attendance and signature
Names of all those wishing to attend the Family Fun Night on Friday 11th August, 6pm-8pm, at Loanends Presbyterian Church (please note any dietary requirements)
Parents Signature*

Clear
Please note, anything written on this form will be held in confidence and only with leaders, as required.
Should be Empty: