Register your child for Apsley Bible Club Details of children Child's full name * First Name Last Name Child's date of birth Second child's full name First Name Last Name Second child date of birth Third child's full name First Name Last Name Third child date of birth Child's address Address 1 Address 2 City State/Province Zip/Postal Code Country Emergency contact Full name * First Name Last Name Phone (main) * (###) ### #### Phone (other) (###) ### #### Relationship to child * Medical details Doctor's name * First Name Last Name Medical practice Doctor's phone (###) ### #### Detail's of any known medical conditions e.g. asthma, diabetes, epilepsy, and any medication being taken: Details of any allergies e.g. foods Consent Photos/videos Any photos/videos taken may be used for promotional purposes within Apsley (including the public ABC Facebook page) If you would prefer NOT to have any photos/videos taken of your child please tick here Travel I give permission for my child to travel on the transport provided: (if relevant) Apsley will only use personal data in connection with its charitable purposes and to inform you about future activities which are relevant to your child. It does not make personal data available to any other individual or organisation. Any other comments By submitting this form I give permission for my child to attend the Apsley Bible Club and to participate in all its activities. I also give consent for the child named to receive immediate first aid and for the Bible Club Leader to sign, on my behalf, any consent required by medical authorities, while seeking to contact me as soon as possible. Thank you!
