Gathered Holiday Club Registration 2026

Gathered Holiday Club Registration 2026

Bushmills
This form is the registration for the Holiday Club ran by Gathered - A Partnership Ministry.

Please complete this form completely and correctly.

Gathered - A Partnership Ministry is a Pioneer Ministry Project in partnership with The Grouped Parishes of Ballyrashane & Kildollagh, The Grouped Parishes of Ballintoy & Dunseverick with Rathlin Island, St Patrick's and St Andrew's Coleraine and Dunluce Parish, Bushmills.

Child's Details
Name of Child

First NameLast Name
Child's Date of Birth

DayMonthYear
Date
Child's Gender
Which Holiday Club Will Your Child attend?
Child's Home Address

Street Address

Street Address Line 2

Town/CityCounty

Post Code

Contact Details
Parent/Guardian's Name

First NameLast Name
Parent/Guardian's Contact Number (Mobile)

Area Code (+44)Phone Number
Parent/Guardian's Email Address
example@example.com
2nd Person with Responsibility for Your Child

Incase you cannot be contacted
Name

First NameLast Name
2nd Person's Contact Number (Mobile)

Area Code (+44)Phone Number
I give permission for my child to join Gathered's Holiday Club at the Partnership Church and times specified in this form and to participate in all the activities of the group. It is my understanding that my specific consent will be sought for any additional activity outside of the above days and times.

Medical Details
Please outline any medical or dietary information we should be aware of (such as allergies, asthma, medication or specific needs)
I give permission for first aid to be administered to my son/daughter
In the case of an emergency, staff and volunteers will do everything reasonable to contact the parent/guardians named in this form. In circumstances where medical treatment is required immediately and where it is not possible to contact those named on this form, do you authorise the leader-in-charge of the group to refer your son/daughter to a medical practitioner or emergency services on your behalf and to sign on your behalf any written consent required in the event of a life-threatening injury/condition?

Consent for Photos and Recorded Images

In accordance with our Safeguarding Trust child protection policy, parent/guardians are asked to give consent for the taking of photographs and recorded images on the understanding that images will only be used for parish communications including the Parish newsletter and Facebook page, Diocesan and Church of Ireland publications both paper and digital and that consent can be withdrawn at any time by contacting your parish office.
Do you consent to the photographing or recording of my child named above?
Do you consent to the photographing or recording of yourself?

Code of Behaviour

The code of behaviour for the children and youth in parish activities is to ensure that children and young people are treated fairly and are aware of their basic rights and responsibilities here. It aims to help foster co-operation, respect and encouragement and prevent unacceptable behaviour
Children, Young People and Leaders are expected to:
- Be friendly and supportive to each other
- Respect the views, feelings and differences of others
- Participate in the group activities
- Respect the property and belongings of others
- Not pressurise anyone to undertake something they are uncomfortable with
- Not use any language or behaviour that could upset or disrespect others
- Refrain from bringing any banned substances to the group such as high-energy drinks, nut-based foods or alcohol
- Refrain from taking photos or sharing information about others online without their expressed permission and the permission of leaders
- Respect the wishes of leaders in directing the activities of the group
- Report risky situations, incidents and inappropriate behaviour to the leadership of the group
- Be willing to apologise to each other when conflict occurs
If a child breaks the code they will be:
1. Reminded of the code and asked to comply in future
2. On consistent non-compliance will be given a formal warning by the leader
3. On continued non-compliance will be given a sanction such as loss of privileges or suspension. This will be recorded and parents informed.
4. Continued non-compliance may result in a longer or permanent suspension from the group. This will also be recorded and parents informed.
Do you agree to promote and/or abide by the code of behaviour as set out above?

GDPR

We are committed to protecting your personal information. The parish will hold and process your personal data for the purpose of contacting you. If you have any questions about how we process your personal data contact a member of the select vestry through your Parish Office.
Do you consent for the Partnership Parishes to hold and process your personal information on behalf of Gathered and to share this information with Gathered?
Please tick ALL ways you would like to be contacted in the future about the activities of the parish.

Policy Information

The church has several policies that relate to working with children and young people, including Safeguarding Trust child protection policy, anti-bullying policy, communications policy, partnership with parents policy, complains procedure and GDPR. If you would like a copy of any of these please see a member of the Parish Panel or contact the parish Office.
I confirm that all information inputted into this form is correct.

Please note that only forms completed and signed by a parent or Guardian of the young person who is the subject of this permission form can be accepted.
Your Name

First NameLast Name
Your relationship to the young person named on this form
Signature
Date this form is completed

DayMonthYear
Date
Should be Empty:

Gathered Holiday Club Registration 2026

Child's Details

Contact Details

2nd Person with Responsibility for Your Child

Medical Details

Consent for Photos and Recorded Images

Code of Behaviour

GDPR

Policy Information