Register


Child's Full Name:

Child known as? (eg. Thomas/Tom)

Gender:
MaleFemale

Date of Birth: (eg. DD/MMM/YYYY)

School:

Current School Year Group:

Parent/Guardian's Full Name:

Address:

Your Email: (Used only for acknowledgement)

Telephone Number:

Emergency Contact Name and Number:

GP's Name and Number:

Any Known Allergies or Conditions:

In the unlikely event of illness or accident, I give permission for any necessary medical treatment to be given to by the nominated first-aider. In an emergency and if I cannot be contacted I am willing for my child to receive hospital treatment, including anesthetic, if necessary. I understand that every effort will be made to contact me as soon as possible;
YesNo

I give permission for my child's photograph to be taken and used on the URC website/magazine/local press:
YesNo

I confirm the above details are complete and correct to the best of my knowledge:
YesNo

We may occasionally contact you with details of future childrens events at Knaresborough United Reformed Church?:
YesNo