Breakout Consent & Registration Form

We are delighted to have your child/young person joining our children & youth activities at Christ Church. We take Safeguarding of your child and protection of your personal data seriously; therefore, we require you to fill in this form. The information that you give us will be stored on record by Christ Church Office and made available to the Breakout team and leaders. More information about our Safeguarding and data protection policy (GDPR) can be found on our website.

 

About Your Child:

Child/young person's full name:

Date of Birth:

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Allergies / Food Intolerances ? (please specify)
Does your child have any medical conditions? (please specify)
Medicals / Special Needs (please specify)
Is there anything else you would like us to know about your child?

 

Family Contact Details:

Full name of parent/guardian:
Relationship to child:

 

Mobile number:
Email address:
Home number:

 

Home address:
Town:
County:
Postcode:

 

Emergency Contact:

Name of carer / alternative adult in case of emergencies:
Relationship to you/your child:
Phone number:

   

What's On Emails:

We have a What's On email that normally goes out once a month letting people know about events we're running including Family events, Sports events and other church activities that might be of interest to them.  You can unsubscribe at any time.
 

I would like to receive your 'What's On' emails:

   

Multimedia:

The use of photos and videos are highly effective in communicating and promoting the value of our children and youth groups. They are also a great way for members to see themselves engaging as a part of the group and to reminisce on fond moments. We need your permission before we can take photographs / videos that include your child.  These photographs and videos will be securely stored and used for wall displays, news updates and publicity (including on our website/social media pages).

May we take, store and use photographs/ videos that include your child?

Yes

No

 

Signed:

 

Signature (please type your full name):