Children's Registration Form

Children's Registration Form
Child's Name*

First NameLast Name
Date of Birth*

DayMonthYear
Current School Stage*
Nursery/Primary/Secondary/Homeschooling
Child's Name

First NameLast Name
Date of Birth

DayMonthYear
Current School Stage
Nursery/Primary/Secondary/Homeschooling
Child's Name

First NameLast Name
Date of Birth

DayMonthYear
Current School Stage
Nursery/Primary/Secondary/Homeschooling
Child's Name

First NameLast Name
Date of Birth

DayMonthYear
Current School Stage
Nursery/Primary/Secondary/Homeschooling
Child's Name

First NameLast Name
Date of Birth

DayMonthYear
Current School Stage
Nursery/Primary/Secondary/Homeschooling
Parent/Guardian Details
Name*

First NameLast Name
Phone*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

TownCity

Post Code
Emergency Contact
Name*

First NameLast Name
Phone*
Relationship to child*
Address*

Street Address

Street Address Line 2

TownCity

Post Code
Medical conditions or allergies we need to be aware of
I give permission for my child/children to be assisted at the toilet if needed*

YesNo
I give permission for photographs/video of my child/children to be used within the church building*

YesNo
I give permission for photographs/video of my child/children to be used in church publicity including social media*

YesNo
The information you provide on this form will only be used for administering events or for emergencies during Lerwick Baptist Church Sunday services and and will be destroyed after it has served its purpose.
Should be Empty:

Children's Registration Form

Parent/Guardian Details

Emergency Contact