Chip Cafe Registration Form

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Welcome to Chips

Please Register by filling in the questions below.

A seperate form is required for each person registering.

 

General Data Protection Regulation, by registering you are agreeing to Giffnock Orchardhill Parish Church storing your information either ellectronically or on paper. Giffnock Orchardhill Parish Church is part of the Church of Scotland and we will not share your information with anyone outside that organisation. For further information regarding how we treat your information please see our privacy document on our website at :- 

http://www.orchardhill.org.uk/about-us/privacy-policy/privacy-notice-2018.php


Name of the person enrolling for Chips:*
Address:*
Parent/ Guardian's Name:*
Home Telephone number:
Mobile Number:
Email Address for updates:
Emergency contact during club (Name & Number):*
D.O.B.:
School /College /Uni:
Name and Number of the young person's G.P.:*
Any illnesses or other medical conditions (e.g.Asthma) allergies/ medication which may affect normal activity?:
In the event of illness or accident, if neither Parent or emergency contact can be contacted I give permission for the young person to receive any necessary medical trreatment from a qualified First Aider or medical practioner.:*
I Agree
No I dont Agree
I give permission for photographs to be taken, which may be used in Church or newspaper publications including the church website.:*
I Agree
No I dont Agree
If there are any other details that you think we should know please enter them here or if you can help during the week also please enter here.:
by checking this box you are electronically signing this form as a true statement and enrolling the person named above for the 2018 Chips Cafe:
I agree Please Enroll the person named for Chips Cafe
Please enter the verification number on the right:*
one four six three two
* Required Fields

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