EPYC Youth Group registration form

EPYC SUNDAY Registration Form
Young Person Information
Young Person's Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

City

Postal / Zip Code
School
School Year
Parent/Carer Information
Parent/Carer Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: 00000000000.
Relationship to young person
Emergency Contact Information
Please provide details of a second contact that we can reach in an emergency if we are unable to get a hold of you
Emergency Contact Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: 00000000000.
Relationship to young person
Other Information
Does the young person have any allergies, chronic illness, or medical condition? If Yes, please describe below.
If YES please describe any allergies, chronic illness, or medical conditions. (if NO, please enter "none" in the box below.)
Does your young person have any dietary requirements?
Any other comments or requests?
Permissions
Travel Home
Does your child have permission to walk home on their own at the end of the session?
Photographs
I understand that authorised photographs or videos may be taken during the club. I give permission for images of my child to be used for feedback from or publicity of the group.
Data Protection
Eaglesham Parish Church promises to look after your data in line with General Data Protection Regulation (GDPR)
Do you wish to receive information through email about other youth opportunities in the future?
Confirmation
BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS THE ORIGINAL MANUAL PAPER SIGNATURE.

(if using a computer that does not have a touch screen use the left mouse and cursor to sign)
Parent/Guardian Signature
Date Signed

MonthDayYear
Date
Should be Empty:

EPYC SUNDAY Registration Form

Young Person Information

Parent/Carer Information

Emergency Contact Information

Other Information

Permissions