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.Format: ***********.
Emergency Contact

First NameLast Name
Emergency Contact's Number
Please enter a valid phone number.Format: ***********.
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
Dates Attending
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.
Permission (Facebook) - I give permission for the above named child's photograph to be taken and uploaded to the church's Facebook page.
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.
- Additional Child's Name (if applicable)
  
  First NameLast Name
- Additional Child's Date of Birth (if applicable)
  
  DayMonthYear
  Date
- Class in school they are entering in September
- Dates Attending (Additional Child)
- Additional 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.
- Permission (Facebook) - I give permission for the above child's photograph to be taken and uploaded to the church's Facebook page.
- 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.
- Additional Child's Name (if applicable)
  
  First NameLast Name
- Additional Child's Date of Birth (if applicable)
  
  DayMonthYear
  Date
- Class in school they are entering in September
- Additional 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:
- Dates Attending (Additional Child)
- Permission (Website) - I give permission for the above named child's photograph to be taken and uploaded to the church's website.
- Permission (Facebook) - I give permission for the above named child's photograph to be taken and uploaded to the church's Facebook page.
- 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.
- 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
- Please note, anything written on this form will be held in confidence and only with leaders, as required.
- Should be Empty: