567 Crew Consent Form 25/26

Children in P5, P6 and P7 are welcome to join us at the 567 Crew on the following Wednesday evenings at the Cuningham Church Hall from 6.30pm to 7.30pm: 8 & 22 October, 12 & 26 November, 10 December, 7 & 21 January, 11 & 25 February, 11 & 25 March.

Each night there will be Bible stories, singing, memory verses, quizzes, games or craft, and refreshments.

Please complete this registration consent form for your child who is attending. If multiple children are attending from the same family, please complete a separate form for each child. Thank you.

Please follow us Facebook to keep up to date with reminders.

For more information please feel free to contact Alastair on:

07400 400 801

Name of child *

Date of Birth *

MonthDayYear

Child’s Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

P5P6P7

Parent/Guardian’s name*

Relationship to child

Parent/Guardian’s email address*

example@example.com

Parent/Guardian’s phone number (emergency contact 1) *

Second Parent/Guardian’s name:*

Second Parent/Guardian’s phone number*

School your child/children attends*

Please give details on any special needs, medical conditions, allergies or dietary requirements affecting your child. Please also share any medication being taken or anything else you think may be relevant for leaders to know while your child is in our care.*

YesNoOther

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 practitioner. *In the event of a medical emergency, a leader will endeavour to contact you as soon as possible using the contact telephone numbers given. *I will inform a leader to any important changes to my child's health, medication or any phone numbers given above

I agree with the statements above and all details I have provided are correct

Yes I give permission to contacted via phone/emailNo I do not want to be contacted

Signature*

567 CREW