Cosy Cafe Registration Form and Cafe Rules

Name *

Parent or Guardians name *

Email Address

Mobile Number

Name and contact emergency number during club hours *

Date of Birth *

Which School do you attend *

Name and contact number of the person registering GP *

Any illnesses or other medical conditions (e.g.Asthma) allergies/ medication which may affect normal activity? N.B our planned activities include cake decorating and a BBQ, please indicate in the box any allergies or dietary requirements for you. *

In the event of illness or accident, if neither Parent or the emergency contact provided can be contacted I give permission for the person being register to receive any necessary medical treatment from a qualified First Aider or medical practitioner. *

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

I understand that Cosy Cafe activities will take place in the Church Halls, grounds and local vicinity with appropriate supervision. *

I Agree

No I Dont Agree

If there are any other details that you think we should know please enter them here.

I consent to Orchardhill storing my data in line with their data protection policy and data retention policy *

I consent under the data protection regulation (GDPR)

No I do not consent and do not wish to register or attend this event. Please delete all my data.

By checking this box you are electronically signing this form as a true statement and enrolling the person named above for the Cosy Cafe *

I agree Please Enroll the person named for Cosy Cafe

Any illnesses or other medical conditions (e.g.Asthma) allergies/ medication which may affect normal activity? N.B our planned activities include cake decorating and a BBQ, please indicate in the box any allergies or dietary requirements for you.