Personal Registration and Consent Form Children and Vulnerable Adults This template can be amended for use by Church Groups for such activities as Day Visits, Camps and Holiday Clubs. This template can also be amended for use as a registration form for adults or used as a registration and consent form for children and vulnerable adults. A new form should be completed annually for each participant. Insert Name of Church Insert Name of Group/Activity Insert Description of the activities involved/specific activity this form relates to Child’s/Adult Details First Name Surname School Name* Date of Birth (*For children) Family Doctor Home Address (Name & Address) Phone Number Email Address Do you/Does your have any food allergies or dietary needs? No Yes* *If yes please give details: – Do you/Does your child have any medical conditions? No Yes* *If yes please give details: – Are you/Is your child taking any medication? No Yes* *If yes please give details: – Do you/Does your child have any special needs? (Including Special Educational Needs, Disabilities or any other special requirements) No Yes* *If yes please give details: – Is there anything else you would like us to know about you/your child? No Yes* *If yes please give details: –
Personal Registration and Consent Form Children and Vulnerable Adults This template can be amended for use by Church Groups for such activities as Day Visits, Camps and Holiday Clubs. This template can also be amended for use as a registration form for adults or used as a registration and consent form for children and vulnerable adults. A new form should be completed annually for each participant. Insert Name of Church Insert Name of Group/Activity Insert Description of the activities involved/specific activity this form relates to Child’s/Adult Details First Name Surname Date of Birth School Name* (*For children) Home Address Family Doctor (Name & Address) Phone Number Email Address Do you/Does your have any food allergies or dietary needs? *If yes – please give details: No Yes* Do you/Does your child have any medical conditions? *If yes – please give details: No Yes* Are you/Is your child taking any medication? *If yes – please give details: No Yes* Do you/Does your child have any special needs? (Including Special Educational Needs, Disabilities or any other special requirements) *If yes – please give details: No Yes* Is there anything else you would like us to know about you/your child? *If yes – please give details: No Yes*
Personal%20Registration%20and%20Consent%20Form.docx