Twinbrook Bible Club

To register for the Bible Club please fill in the Consent Form below. Alternatively you can fill in a paper consent form on arrival on the first evening.

Bible Club Consent Form

Consent Form

Child’s Name:

Date of Birth

Address:

Address Line 1

Address Line 2

Town/City

County

Post Code

Emergency Contact Name:

Relationship To Child:

Emergency Contact Number (Home):

Emergency Contact Number (Mobile):

Parent or Guardian’s Email Address:

Medical

Name of Family Doctor:

Address of Surgery:

Address Line 1

Address Line 2

Town/City

Post Code

Doctor Telephone Number:

Details of any known conditions, allergies etc (eg. asthma, diabetes, epilepsy) and any medication being taken:

Consent

Any photos/videos taken may be used for promotional purposes within BCM (including the public Facebook pages + Instagram).

I am happy for my child to be in photos/videos

I would prefer my child NOT to be in any photos/videos

Is your child permitted to return home on their own or with friends when the Bible club finishes?

Yes

A parent, carer, or another designated adult, must collect your child at the end of the Bible Club. If there is a problem with this some week please contact Judith 07980279847.

By signing below I give permission for my child to attend the Bible Club and to participate in all its activities. I also give consent for them to receive immediate first aid and for the Bible Club Leader to sign, on my behalf, any consent required by medical authorities, while seeking to contact me as soon as possible.

I agree

Electronic Signature by Parent/Guardian: (Please type your first and last name which is deemed to be the equivalent of your signature):

BCM will only use personal data in connection with its charitable purposes and to inform you about future BCM activities which are relevant to your child. It does not make personal data available to any other individual or organisation. Full details of our privacy notice can be found at Privacy Notice – BCM International NI

Consent Form

Medical

Consent

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