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PETERBOROUGH
CITY CHURCH

DOMICILE
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REGISTER YOUR CHILD

THIS FORM IS TO HELP US SAFEGUARD YOUR CHILD SO PLEASE ENSURE ONE IS SUBMITTED PER CHILD.

CHILD INFORMATION

CHILD'S FULL NAME*

CHILD'S DATE OF BIRTH*

Jour

Mois

Année

HOME ADDRESS*

EMERGENCY CONTACT/S

PARENT/GUARDIAN FULL NAME 1*

PARENT/GUARDIAN CONTACT NO 1*

PARENT/GUARDIAN EMAIL*

PARENT/GUARDIAN FULL NAME 2

PARENT/GUARDIAN CONTACT NO 2

ABOUT YOUR CHILD

DOES YOUR CHILD HAVE ANY NEED/S WE MUST KNOW? *

IF NO PLEASE WRITE N/A, IF YES PLEASE PROVIDE DETAILS.

WE MAY SOMETIMES PROVIDE A SNACK AND DRINK FOR YOUR CHILD, DOES YOUR CHILD HAVE ANY ALLERGIES OR INTOLERANCES? *

IF NO PLEASE WRITE N/A, IF YES PLEASE PROVIDE DETAILS.

DOES YOUR CHILD TAKE ANY MEDICATION?*

IF NO PLEASE WRITE N/A, IF YES PLEASE PROVIDE DETAILS.

DOES YOUR CHILD HAVE ANY BEHAVIOURAL, EMOTIONAL OR LEARNING NEEDS WE NEED TO BE AWARE OF? *

IF NO PLEASE WRITE N/A, IF YES PLEASE PROVIDE DETAILS.

IS THERE ANYTHING ELSE WE MUST KNOW AS WE CARE FOR YOUR CHILD?*

IF NO PLEASE WRITE N/A, IF YES PLEASE PROVIDE DETAILS.

PERMISSIONS

WE LOVE TO CAPTURE THE AMAZING EXPERIENCES THE CHILDREN HAVE UPSTAIRS SO THAT YOU CAN SEE WHAT THEY GET UP TO!

DO YOU GIVE PERMISSION FOR YOUR CHILD TO HAVE THEIR PHOTO TAKEN - IF YES PLEASE SELECT ALL THAT APPLY, IF NO PLEASE SELECT THE REFLECTING OPTION*

PETERBOROUGH CITY CHURCH PUBLIC FACEBOOK PAGE

PETERBOROUGH CITY CHURCH PRIVATE FACEBOOK PAGE

PETERBOROUGH CITY CHURCH INSTAGRAM

PETERBOROUGH CITY CHURCH WEBSITE

ON DISPLAY BOARDS WITHIN THE CHURCH BUILDING

PETERBOROUGH CITY CHURCH WELCOME BOOKLETS

PETERBOROUGH CITY CHURCH NEWSLETTERS

I DO NOT GIVE PERMISSION FOR MY CHILD'S PHOTOGRAPHS TO BE USED IN ANY CAPACITY

DECLARATION

I CONFIRM THAT THESE QUESTIONS HAVE BEEN COMPLETED CORRECTLY AND I WILL INFORM FAITH SYMONS OF ANY CHANGES THAT MAY OCCUR

SIGNATURE*

Le mode de dessin a été sélectionné. Le dessin nécessite une souris ou un pavé tactile. Pour l'accessibilité du clavier, sélectionnez « Saisir » ou « Importer ».

FULL NAME OF PERSON COMPLETING FORM*

DATE OF FORM COMPLETION*

Jour

Mois

Année

DOMICILE
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DONNER
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