Annual Registration and Medical Form: 2025/26

Annual Registration and Medical Form: 2025/26
Number of children you are registering:*

123
Specified Activities: Dubsters & 3DUB youth groups meet at St John’s Church, Welling for general meetings (Sunday evening youth groups and mid-week Cell Group). Other activities may include: Transform / Youth Services, 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
Medical Information of Child 1
Name and Address of Doctor*
Telephone*
Medical Conditions, Medication & Dietary Needs
Does your child have any medical condition, allergy, phobia, or require regular medication (including epi-pen, inhaler, etc.)? If yes, please give details, including any medication they need to carry and any dietary requirements (allergies, intolerances, etc):
Additional Needs / Support
Does your child have any additional support needs (e.g., learning, health, wellbeing) or any activity restrictions?If yes, please give details:

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

MonthDayYear
Date
Medical Information of Child 2
Name and Address of Doctor (if different from child 1)
Telephone (if different from child 1)
Medical Conditions, Medication & Dietary Needs
Does your child have any medical condition, allergy, phobia, or require regular medication (including epi-pen, inhaler, etc.)? If yes, please give details, including any medication they need to carry and any dietary requirements (allergies, intolerances, etc):
Additional Needs / Support
Does your child have any additional support needs (e.g., learning, health, wellbeing) or any activity restrictions?If yes, please give details:

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

MonthDayYear
Date
Medical Information of Child 3
Name and Address of Doctor (if different from child 1)
Telephone (if different from child 1)
Medical Conditions, Medication & Dietary Needs
Does your child have any medical condition, allergy, phobia, or require regular medication (including epi-pen, inhaler, etc.)? If yes, please give details, including any medication they need to carry and any dietary requirements (allergies, intolerances, etc):
Additional Needs / Support
Does your child have any additional support needs (e.g., learning, health, wellbeing) or any activity restrictions?If yes, please give details:

Parent/Guardian Details - Emergency Contacts
Parent/Guardian 1:
Name*
Address*
Phone Number*
Email
example@example.com
Please add me to the Dubsters & 3DUB Parents’ WhatsApp group to receive youth updates.
Parent/Guardian 2:
Name
Address
Phone Number
Email
example@example.com
Please add me to the Dubsters & 3DUB Parents’ WhatsApp group to receive youth updates.

Travel & Attendance Consent