Name
*
First Name
Last Name
Address
*
Date of Birth
*
MM
DD
YYYY
Age
*
School year
*
Gender
*
Parents' email address
*
First contact
*
First Name
Last Name
Relationship
*
Mobile number
*
(###)
###
####
Address
*
Second contact
*
First Name
Last Name
Relationship
*
Mobile number
*
(###)
###
####
Address
*
Name of GP
*
GP address
My child will normally be collected at the end of the session by (insert name/s):
My child is allowed to walk and make their own way home:
*
Parent / carer declaration
*
By ticking this box, I confirm that the above details are complete and correct to the best of my knowledge.
I understand the participant will be under the care of the group leader(s) throughout the activity and give my consent for the participant to take part.
I confirm that any medication required by the participant will be labelled with their name. I understand that epi-pens and inhalers will be kept with the participant at all times. Other medication, e.g. antibiotics, will be in a clear, sealable, plastic bag labelled with the participant's name.
I understand that the leaders of this group will be responsible for under 18's medication.
In the unlikely event of illness or accident, I give permission for any appropriate first aid to be given by the nominated first-aider.
In an emergency, and if I cannot be contacted, I am willing for my child to be given medical, dental or hospital treatment, including anesthetic if necessary. I understand that every effort will be made to contact me as soon as possible.
Photo permissions
*
By ticking this box, I give permission for my child to be included in photos and videos taken during the events, and used to promote the events and other activities run by the Western Dales Mission Community. We will take steps to ensure that these images are used solely for the purposes intended and images will not include names or identifying information.
Mailing list
GDPR consent
*
By checking this box you are consenting to the Western Dales Mission Community holding and processing your data to keep you informed about news, events, activities and services. We will not share your contact information with anyone else without your permission unless required to do so by law. You can withdraw or change your consent at any time by contacting the WDMC administrator – admin@westerndales.org.uk. (Please note that individual churches may continue to hold personal data on the GDPR grounds of a charitable body having a ‘legitimate interest’ for holding data for carrying out its purposes such as communicating with its members).
Any comments or questions?
Form completed by:
*
First Name
Last Name
Relationship to participant:
*
Date
*
MM
DD
YYYY
Thank you for registering your child to take part in our youth activities!
If, at any time, you need to update these details, please contact ben.maunder@westerndales.org.uk .
