KCC Bright Lights Party

Thursday 31st October 2024, 6:30pm - 8:00pm

Child Registration (For ages 5 to school year 6.)

One form per child please.

Child's Name

Gender

Male

Female

Birthday

Age

Emergency Contact Details

Emergency Contact Name & relationship to child.

Mobile Number

Email Address

Alternative Emergency Contact Name & Number

Medical

Details of any regular medication, medical conditions (e.g. asthma, epilepsy, diabetes) or disability that we should be aware of. Please write details in box below.

Details of any allergies or dietary requirements.

Permissions

This section must be completed by those with parental responsibility.

During the party we may take photographs and video footage to be used in our church publicity (e.g. video announcements, church website, posters etc.) Please answer the following questions below.

I give my permission for Kingswinford Christian Centre to use my child's image in any appropriate publicity.

Yes

No

I give permission for my child to take part in all the normal activities of the Bright Lights Party.

Yes

No

I understand that my child will be under the care of adults approved by the church, and although they will take all reasonable care of my child, they cannot be held responsible for any loss, damage or injury suffered during or as a result of activities.

Yes

No

In an emergency and/or if I am not contactable, I am willing for my child to receive doctor/ hospital or dental treatment including anaesthetic.

Yes

No

Signed

Name (Parent/Carer)

Date

The information requested on this form can be completed by a carer, but only those with parental responsibility can complete the permission section.

Kingswinford Christian Centre, Summer Street, Kingswinford, DY6 9NA.

Tel: 01384 297106

Registered Charity Number: 1052747

All details will be kept secure in line with our GDPR policy and disposed of after 1 year if no longer required.

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KCC Bright Lights Party

Emergency Contact Details

Medical

Permissions

Signed