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Who Are You Form

Registration for Loughbrickland Connect will start on Saturday 1st 2pm-4pm. Please print a copy and bring it completed either on the Saturday or the Monday. Forms will also be available on the day or you can pick them up in local shops and church services

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Johnny Stewart
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57 views1 page

Who Are You Form

Registration for Loughbrickland Connect will start on Saturday 1st 2pm-4pm. Please print a copy and bring it completed either on the Saturday or the Monday. Forms will also be available on the day or you can pick them up in local shops and church services

Uploaded by

Johnny Stewart
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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WHO ARE YOU?

FORM
Year 2015
Surname
Age

Please give details of any medical conditions (e.g. asthma, epilepsy,


diabetes, allergies, dietary needs) or disability that may be affected
by this activity

First Name
Year group*

Date of Birth

Home Address
Post Code
Holiday Address
Post Code

Group Leader
Authorisation of Parent / Guardian:
My child is permitted to attend and participate in all the activities of the
mission.
I (having parental responsibility for the above named person) give consent
to any emergency medical treatment that may be necessary during the
duration of the mission.

Name of parent(s)/guardian(s)
Parent/guardian email

Please tick if appropriate:


Emergency Contact 1
Name
Home Number
Mobile

Emergency Contact 2
Relationship
Home Number
Mobile

Name of Church (if attended)


Name of School *
*Please give school / year group for next year.

I give permission for my childs name to be passed on to the SU


Coordinator or SU Rep in their school, to let them know that they have
attended this event

Relationship

Name

My child is permitted to walk home alone

Photographs and video


Some photographs and video taken on SU activities are used in publicity
materials and on the SU or Team Website, including Social Media e.g.
Facebook. In signing this form you consent to photographs and video being
used for such purposes.
Please tick here if you DO NOT want photographs to be used for these
purposes.

Signed:

(Parent / Guardian)

Date:
DATA PROTECTION: In returning this form you agree to the Team Leader holding your contact
details as part of a computer record. The Team Leader will not share this information with any
other agency, but may, from time to time contact you or your child/young person to let you
know about reunions or to give you information about summer 2011. We will not hold this
information for longer than in necessary.

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