OY Summer Club Registration Form - Orchardhill Parish Church

Name of the person enrolling for OY Summer Club *

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 person registering's G.P.

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 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

I understand that Chips Summer Club activities will take place in the Church Halls, grounds and local vicinity with appropriate supervision.

Yes I agree

Please choose whether or not, you give permission for the person registered to walk home at the end of the evening. i.e. If you choose YES They will not require an adult to pick them up at 9pm. *

Yes They can make there own way home.

No A parent or Guardian will collect them at 9pm.

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

By checking this box you are electronically signing this form as a true statement and enrolling the person named above for the 2024 OY Cafe *

I agree Please Enroll the person named for the OY Summer Cafe