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01458 897337
Street Baptist Church, Glaston Road, Street, Somerset, BA16 0AN

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Home
Join us
- What to expect
- Services & Groups
Teaching
Who we are
News & Events
Contact us

Youth Zone Registration

Registration for young people attending Youth Zone Sunday and Youth Zone Club weekday activities from September 2021 to August 2022

Details of young person attending

Dates attending

10th Sept 17th Sept 24th Sept 1st Oct 8th Oct 15th Oct 22nd Oct

Full Name

Date of birth

Sex

Female Male

Address

Postcode

Any medical conditions, allergies, medication or special needs we should be aware of?

Parent/Carer contact details – please provide two contacts

Please note, we will use the email address and mobile number provided for the first contact as the primary contact details to inform you of plans and activities.

First Parent/Carer

Name

Relationship to young person

Mobile number

Email Address

Telephone Number

Second Parent/Carer

Name

Relationship to young person

Mobile number

Email Address

Telephone Number

Parent/Carer Consents

I give consent for my child to participate in the above-mentioned group and, having read the information sheet, agree to their participation in any or all of the activities described. I acknowledge the need for acceptable responsible behaviour on their part. I acknowledge that while involved they will be under the control and care of the group leader and/or other adults approved by the organisation and that, while the staff in charge of the group will take all reasonable care of the children, they cannot necessarily be held responsible for loss, damage or injury suffered by him/her during, or as a result of, the activity.

Acknowledged

In the unlikely event of illness or accident, I acknowledge that medical treatment may be given by the nominated first-aider. I consent that in an emergency and if I cannot be contacted, I am willing for my child to receive any treatment a hospital/doctor may consider necessary. I understand that every effort will be made to contact me as soon as possible.

Acknowledged

I consent to my child’s image being included in photographs/videos taken at the club. Photographs/video recordings may be shown in our church services, displayed in the church, on the church website or used in news articles. Names will not be attached to photographs.

Yes No

I understand that my details will be held electronically by Street Baptist Church for a period of up to two years. I give permission for these details to be used to contact me in relation to Youth Zone.

Yes

Is the young person permitted to leave the club without a parent or guardian collecting them?

Yes No

I confirm that the details are complete and correct to the best of my knowledge

Confirmed

Name of parent or carer signing for the young person

Address if different from the young person

01458 897337
Street Baptist Church, Glaston Road, Street, Somerset, BA16 0AN

© Street Baptist Church

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