Annual Registration and Medical Form: 2024/2025

Annual Registration and Medical Form: 2024/2025
Number of children you are registering:*

123
Specified Activities: Youth Groups (dubsters/3DUB) on Sunday Evening, mid-week socials/Cell Group, Youth Services at St John's Church, Transform Bexley Youth Events, Youth Alpha Events and local outings.
Parents/Guardians please read and complete the following sections:

Details of the Child 1
Full name of Child*
Home Address*
Date of Birth*

MonthDayYear
Date
Name of Parent(s)/guardian(s)*
Medical Detail of the Child 1
Name and Address of Doctor*
Telephone*

Area CodePhone Number
Telephone*
National Health Number (if known)
Date of last anti-tetanus jab (if known)

MonthDayYear
Date
Please answer the following questions:
Does your child suffer from any medical condition allergies or phobias or is on any medication
If your child is taking medication does he or she need to carry the drugs on their person
Is there any activity that your child should not be allowed to participate in

Details of the Child 2
Full name of Child*
Home Address*
Date of Birth*

MonthDayYear
Date
Name of Parent(s)/guardian(s)*
Medical Detail of the Child 2
Name and Address of Doctor*
Telephone*

Area CodePhone Number
Telephone*
National Health Number (if known)
Date of last anti-tetanus jab (if known)

MonthDayYear
Date
Please answer the following questions:
Does your child suffer from any medical condition allergies or phobias or is on any medication
If your child is taking medication does he or she need to carry the drugs on their person
Is there any activity that your child should not be allowed to participate in

Details of the Child 3
Full name of Child*
Home Address*
Date of Birth*

MonthDayYear
Date
Name of Parent(s)/guardian(s)*
Medical Detail of the Child 3
Name and Address of Doctor*
Telephone*

Area CodePhone Number
Telephone*
National Health Number (if known)
Date of last anti-tetanus jab (if known)

MonthDayYear
Date
Please answer the following questions:
Does your child suffer from any medical condition allergies or phobias or is on any medication
If your child is taking medication does he or she need to carry the drugs on their person
Is there any activity that your child should not be allowed to participate in

Parent/Guardian Details - Emergency Contacts
Parent/Guardian 1:
Name*
Address*
Phone Number*

Area CodePhone Number
Phone Number*
Email
example@example.com
Parent/Guardian 2:
Name
Address
Phone Number

Area CodePhone Number
Phone Number
Email
example@example.com
I agree to any emergency medical treatment as considered necessary by the medical authorities if I cannot be contacted. 2.
Full Name of parent(s)/guardian(s):*

GDPR Permissions: 1.

Your privacy is important to us and we would like to communicate with you about the church and its activities. To do so we need your consent. You can find out more about how we use your personal data by reading our privacy notice, which you can find here: http://www.stjohnswelling.org.uk/data-protection/
We may contact you about groups and activities you or your child may be interested in participating in.

I would like to receive communications by emailI would like to receive communications by mobile phone including text messageI would like to receive communications by social media
I give consent to my child attending St Johns Youth groups and taking part in the specified activities listed at the top of this form including local outings*

Clear
Date:*

DayMonthYear
Date
Please inform us of any changes
1. You can grant consent to all the purposes; one of the purposes or none of the purposes. Where you do not grant consent we will not be able to use your personal data; (so for example we may not be able to let you know about forth- coming services and events); except in certain limited situations, such as where required to do so by law or protect members of the public from serious harm. You can find out more about how we use your data from our "Privacy Notice" which is available from our website or from the Parish Office or at http://www.stjohnswelling.org.uk/data-protection/. You can withdraw or change your consent at any time by contacting the Parish office

2. The medical profession takes the view that a parent's consent to medical treatment cannot be delegated. This view is explicit in the Children's Act 1989. Medical consent forms have no legal status and a Doctor has the right to insist on parental consent to treat a child. However it can be a comfort to medical staff to have general consent in advance from parents or have a leader on hand to sign forms. Please inform us of any changes.
Should be Empty:

Annual Registration and Medical Form: 2024/2025

Please inform us of any changes