Children and Young People: Annual Registration and Medical Information Form

We require the parents or legal guardians of all children who enrol for our activities to complete a Registration and Medical Information Form each year (academic) year.

For your convenience, you can now complete this online. If your children wish to take part in any of the activities at which parents are not present (Sunday Special, Explorers, Wednesday Club, or Holiday Club) during the academic year 2018-19, you need to complete this form - either on paper or online. It is important that this information is kept up to date: Please notify us of any changes.

Child's Details
The usual name by which they are known
Parent's Details
We need contact details for one parent or legal guardian.
Please give both your first name and your surname.
We will use this to send you a copy of the details you are giving us now, and we may use it to let you know of other updates or pieces of news. We never give information to any other organisation, except if required by a legal authority.
Medical Details
If your medical practice allows you to see any GP at the practice, you may give the name of the practice instead.
Medical History / Needs

If the answer to any of the following questions is YES, please give details in the box at the bottom of this section.

Has the child ever been actively sensitive to Penicillin
Does the child suffer from any allergies?
Does the child carry any medication that needs to be taken regularly
Does the child suffer from a condition or illness requiring regular treatment?
Is you answered "YES" to any of the questions above, please give details
Consent
I agree that the child I am enrolling may take part in activities organised by St Mary's Church, Kemsing, including any organised trips. I understand that while involved, he/she will be under the control and care of the group leader and/or other adults approved by the PCC, and that, while the staff in charge of the group will take all reasonable care of the children, they cannot necessarily be held responsible for an loss, damage or injury suffered by any child during, or as a result of, the activity.
In the event of illness or an accident requiring emergency hospital treatment, I authorise the leader(s) to give consent to treatment.
From time to time, we may take photos / videos of group activities. I consent for photographs or videos of my child to be used (the child's name never being published) on notice boards, for information or publicity, displayed in photo albums, or put on the church website (either directly, or using a 3rd party photo / video upload service).
I am giving consent for the child named on this form to take part in activities during this academic year. (This box has been completed for you).
I confirm that I am the parent or legal guardian named on this form.