Team Builders Registration Form

Team Builders Registration Form

Fill out the form carefully for registration
Days booking for
Child's Name

First NameLast Name
Birth Date

DayMonthYear
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postcode
Parent/Gaurdian Details

NameTelephone Number
E-mail
example@example.com
Emergency Contact (different to contact)

NameNumber
I give permission for my child and my details to be entered into the Church database
I give permission for my child’s photo to be taken during the club
Any known allergies or conditions?
GP's Name and telephone number

NameTelephone number
I confirm that the above details are complete and correct to the best of my knowledge. in the unlikely event of illness or accident, I give my permission for any appropriate first aid to be given by the nominated first aider. In an emergency, and if cannot be contacted, I'm willing for my child to be given hospital treatment, including anaesthetic if necessary. I understand that every effort will be made to contact me as soon as possible.
Please Sign here
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Should be Empty: