St. Mary´s Youth Registration Form

St. Mary´s Youth Registration Form
Please fill in all fields that are marked with an asterix.
Name of Young Person*
D.O.B.*
Name of Parent(s)*
Address*
Parents Contact No.*
Parents email*
Contact Permission: We like to make contact with the young people via Facebook, Twitter, text and email and we feel this is a valuable way of keeping pastoral contact with your son/daughter as well as keeping them informed of the club’s activities and events. Can we have permission to contact your son/daughter in the week?*

YesNo
Photo/Video Permission: Do we have your permission to take photos and videos of your son/daughter? As part of our regular activities we sometimes take photos and film of our activities. Photos and video footage are usually shared with the young people and some might be used in our publicity. All photos and videos are stored securely.*

YesNo
Young Persons e-mail
While your son/daughter is in our care it would be helpful to know whether he or she suffers from any allergies or phobias, is on any medication and any other health and dietary issues we need to be aware of:
What club/s does your son/daughter usually attend? (Please tick all that apply)

Sunday Morning YouthSMYLERISEHouse GroupBoys GroupGirls Group
By submitting this form, I agree to my son/daughter attending the activities organised by St. Mary’s Church, Amersham and give my consent to attending the regular youth group activities. I understand the youth team are not responsible for their personal property, money or clothes taken to the group and that the youth team cannot take responsibility for the administration of any medicines.*

I have read and agree with this statement
St. Mary’s Youth Clubs are for young people in year six and secondary school years and are run by St. Mary’s Church, Amersham. The youth team have all been approved to work with children and all the information supplied to us on this form will be kept in both a paper and electronic format, stored securely, processed fairly and lawfully and will not be disclosed to third parties.
Should be Empty: