Shout Registration and Consent Form

Group/Activity attending Shout – School Years 3-6 (6:30-7:30pm)

Full Name of Child

Date of Birth

Address

Postcode

Name of Parents/Carers

Parent's Phone No

Alternative emergency No

Parent's e-mail address

School & Year

Medical Information – please provide details of any:

• Medical condition or disability

• Allergies or dietary needs

• Special needs

• Behavioural concerns

Extra Information

* Please note that we reserve the right to ask a parent or guardian to remain with a child if we do not feel we would be able to provide adequate care for that child

What happens to this information? We will store this information on the church premises in a locked place and destroy it when the child leaves the group. We will not pass the information on to any third parties. You have a right to ask to have the information destroyed at any time by contacting Graham Sumbler - graham.sumbler@woodleybc.org.

Consent

I give permission for my child’s details to be kept by Woodley Baptist Church for the purpose of communicating with me as parent/guardian with regard to the group my child attends.

I give permission for photos and videos featuring my child to be recorded and used on the church website and for in-house display and publicity.

In an emergency, if I cannot be contacted, I give permission for my child to receive first aid or necessary hospital treatment, including an anaesthetic.

I understand that, while those working with my child will take all reasonable care, they cannot be held responsible for any lost items, damage or injury suffered by my child during, or as a result of, the activity.
I undertake to inform the group leader (07725 905427 or graham.sumbler@woodleybc.org) should any of the above information change.

Printed name

Date

Please note: Signed consent given by submitting this form (Only those with parental responsibility can sign the consent)

If you’ve got a question, please get in touch. We are more than happy to help.
The church office is open from 08:30 to 12:30, Monday to Fridays if you fancy dropping by or we can be contacted by telephone on: (0118) 9699956. Alternatively send us an email using the form below.

How to find us

Woodley Baptist Church, Hurricane Way, Woodley, Reading, Berkshire, RG5 4UX, United Kingdom.

Parking can be found outside the Tesco Express (for SatNav directions to this car park please enter RG5 4UL) with access to the church gained through the walkway past Pizza Hut. A smaller number of spaces are available in the car park beside the Loddon Vale (GP) Practice. During surgery hours please leave the spaces on the left of the car park for the use of patients.

Shout Registration and Consent Form

Group/Activity attending Shout – School Years 3-6 (6:30-7:30pm)

How to find us

Getting hold of us

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If you pay tax, please tick the Gift Aid box – this adds 25% to the value of your gift at no extra cost to you.

Shout Registration and Consent Form

Group/Activity attending Shout – School Years 3-6 (6:30-7:30pm)

How to find us

Getting hold of us

GIVE ONLINE

Giving just got easier! Simple and secure. Give a single gift, or schedule ongoing donations using your debit, or credit card.

If you pay tax, please tick the Gift Aid box – this adds 25% to the value of your gift at no extra cost to you.

Giving just got easier!

Simple and secure. Give a single gift, or schedule ongoing donations using your debit, or credit card.