Youth Club Registration Form

Part One: General Information

At Princes Street Evangelical Baptist Church we believe that the safety of our young people and children is very important. As an organisation we ensure that all our leaders are DBS checked. We appreciate your help as you fill out this form.

Please note that the information on this form is for the use of the youth leaders at Princes Street Evangelical Baptist Church and is not available to any other individuals or groups. This means that we will not disclose your e-mail address, mobile number or any other details to another individual without your permission. This form allows Princes Street Evangelical Baptist Church important medical information for our records along with permission for use of photos and communication.

Childs Name

Birthdate

Name of Parent/ Guardian

Address

Email Address

This address will receive a confirmation email

Phone

Part Two: Emergency Contact Information

In the event of an emergency relating to your son/daughter please provide a secondary contact which we can then use if the primary carer is unavailable.

Adult Emergency Contact Name

Emergency Contact Number

Are there any special dietary needs which we should be aware of (e.g. food allergies)

Are there any medical conditions that we should be aware of (e.g. allergies, asthma, diabetes, etc.)?

Permissions

I understand that by submitting this form I give permission to PSEBC to store the information herein in compliance with current data protection laws and understand this will not be shared.

I give my permission for my child to be escorted to and from the main building on Princes Street to the Sunday School hall on Porthkerry Road.

Yes No

I give my permission for my child's image to be printed and/ or posted on a website or social network page associated with PSEBC.

Yes No

I agree to receiving occasional communication from a Youth Club member relating to church activities or in case of an emergency.

Yes No

Additional Information for Safeguarding your child

Description

Please fill out this form and click submit.

Youth Club Registration Form

Description

Please Fix the Following