Child's First Name: Child's Surname: Date of Birth: dd12345678910111213141516171819202122232425262728293031 mmmJanFebMarAprMayJunJulAugSepOctNovDec yyyy202520242023202220212020201920182017201620152014201320122011201020092008200720062005 Gender: --FemaleMale School Year (as of September 2024): --Reception12345678910111213
Emergency Contact Numbers 1. Name of Contact: Relationship to Child: Contact Number: 2. Name of Contact: Relationship to Child: Contact Number: Please give details of anything we need to be aware of: Medical Conditions (e.g. Asthma) Allergies/Dietary (e.g. Hayfever) Medication Behavioural needs to be aware of (e.g. Autism, ADHD) and then please contact Nic Bianchi as to how we may best support your child.
I give permission for my child to attend groups on Fridays and/or Sundays which may include visits to local places (e.g. Cheam Park or trips to London etc.), or other events further afield. Please note: This form is intended to give us permission, with your consent, to take your children to local and other events. The intention is that you won’t have to duplicate consent forms, but give your permissions all on this one form. Obviously we will let you know when we intend on taking them on trips – so please do ensure we have your full contact details in order to be able to do that.
Information about you and your child in this form will only be used for keeping a record of and managing your child’s involvement with CBC’s children's and youth activities. This information will be kept confidentially and securely, and may be disclosed outside of CBC but only with your consent and with appropriate safeguards. Information on this form will be kept on CBC’s records only whilst your child attends CBC’s youth activities and will be deleted from CBC’s records as soon as possible after your child ceases to attend. The information in this form may be used to contact my child, if they are 15 years old and over only, about any youth events or activities via Facebook/text or other media. -YesNo Photographs/video footage of my child may be used in displays in the church buildings, in presentations of the church youth work or on the church website or social media. You have the right to withdraw your consent to CBC’s handling this information at any time, a free right of access to any information about you kept by CBC, the right to have information about you kept by CBC deleted, corrected or restricted to a specified purpose at your request, and the right to complain to the UK Information Commission if you believe that CBC has misused any information about you. I consent to information about me and my child being handled by CBC as outlined above: Parent/Guardian's Name:
If your child attends Friday Kids Club or Friday Youth the cost is £10.00 per term, and payment may be made online. For the payment reference please use the surname used on the registration form pre-fixed with ‘FKC’ (Friday Kids Club) or 'FYW (Friday Youth Work). The bank account details are: Bank: Barclays Account Name: Cheam Baptist Church Account Number: 53532542 Sort Code: 20-57-76 Reference: FKC-Child's Surname (for children attending Friday Kids Club) or FYW-Child's Surname (for children Friday Youth Work)
If you have any questions please contact Nic Bianchi by
email: nic.bianchi@cheambaptist.net telephone: 020 8642 5070