Online Registration Form

Child's Full Name:
Child known as? (eg. Thomas/Tom)
Gender:	Male Female
Date of Birth: (dd/mm/yyyy)
School:
Parent/Guardian's Full Name:
Address:
Email Address: (used only for acknowledgement)
Your Telephone Number:
Emergency Contact Name and Number:
GP's Name and Number
Any Know 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 anaesthetic, if necessary. I understand that every effort will be made to contact me as soon as possible;	Yes No
I give permission for my child's photograph to be taken and used on the URC website/magazine/local press:	Yes No
I confirm the above details are complete and correct to the best of the knowledge:	Yes No
We may occasionally contact you with details of future childrens events at Knaresborough United Reformed Church?	Yes No

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