Fit for a King Summer Holiday Club Registration Form

Fit for a King Summer Holiday Club Registration Form
When: 10 am - 12 noon on Monday 3rd August through to Friday 7th August

Where: The Carswell Centre, Montgomery St, Eaglesham, Glasgow G76 0AS

Who: For young people in P1-P7

PLEASE COMPLETE A SEPARATE REGISTRATION FORM FOR EACH CHILD WHO WILL ATTEND
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
Primary year finished:
Please select all dates the young person will attend:
How did you hear about the "Fit for a King" Holiday Club?
Parent/Carer Information
Parent/Carer Name

First NameLast Name
Email
example@example.com
Daytime Phone Number
Please enter a valid phone number.Format: 0000-000-0000.
Relationship to young person
Emergency Information

Please make sure this is different from the above parent/carer
Emergency Contact Name

First NameLast Name
Daytime Phone Number
Please enter a valid phone number.Format: 0000-000-0000.
Relationship to young person
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 the young person have any additional support needs?
If YES, please give details of any additional support needs and ideas on how best to manage them. (If NO, please enter "none" in the box below)
Any other comments or requests?
Permissions
Parental Consent and Acknowledgement
I give permission for my child, as named above, to take part in the normal activities of 'Fit for a King Holiday Club'. I understand that while involved in the club they will be under the control and care of the group leader and/or other adults approved by Eaglesham Parish Church leadership and that, while the staff in charge of the group will take reasonable care of the children, they cannot necessarily be held responsible for any loss, damage or injury suffered by the child during, or as a result of, the activity.

In the event of illness or accident, I give permission for any necessary medical treatment to be given by the nominated first aider. In an emergency and if I cannot be contacted, I am willing for my child to receive hospital treatment if necessary. I understand that every effort will be made to contact me as soon as possible.
Responsibility for Young Person Arriving/Departing from Sessions
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?
Email
example@example.com
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:

Fit for a King Summer Holiday Club Registration Form

Young Person Information

Parent/Carer Information

Emergency Information

Permissions