Child's name *

First Name

Last Name

Sex *

Male

Female

Parental Consent - I give permission for my child as named above to take part in the normal activities of the club. *

YES

NO

In an emergency and/or I cannot be contacted, I am willing for my child to be receive necessary hospital or dental treatment including an anaesthetic. *

Yes

No

Does your child have any regular medication, medical conditions (eg asthma, epilepsy, diabetes), additional needs or disability that may affect this activity. *

YES

NO

There will be a snack provided during the event. Does your child have any allergies or dietary needs. *

YES

NO

Is there any other information you would like to provide to help your child enjoy the club? *

YES

NO

I am happy for John Knox Church to retain the contact details above and to contact me or my child about future events for families or children at John Knox church *

Yes

No

At John Knox Church we are committed to ensuring church activities follow good practice. Are you are happy for us to take photographs and video of your child during the event? *

YES

NO

If yes please detail where they may be used.

For inclusion in John Knox Church’s publications, whether in print or electronic format

Within the church premises eg notice boards

On the church website and social media channels eg Facebook page, Twitter, Instagram

For inclusion in any of the Congregation’s publicity, presentations, banners or marketing material

For inclusion in local publications eg Kilmarnock Standard, The Review magazine