Please Complete This Form So That Your Child Can Continue to Safely Access Kerith Kids

Please complete this form so that your child can continue to safely access Kerith Kids.

We highly value the personal data you share with us. We promise to keep your information secure, to use your information submitted here solely within the church and not to use it for marketing purposes. Feel free to read our privacy policy, available at to explain how we use personal data.
By submitting your child’s details on this form, you consent to us storing your information for the purposes described. If you do not wish for us to do this, please do not submit your details.

1. Personal Information

Full name of child:

Male/Female

Name child is known by if different from above:

Date of Birth:

Address:

2. Carer's Information

Names of parent(s)/carer(s):

Relationshipto child:

Emailaddress(es)

Tel no(s):

Address:

Additional contact (in case of emergencies):

Name:

Relationship to child:

Tel no:

3. On a Sunday, which site(s) does your son/daughter normally attend?

Bracknell/Sandhurst/Windsor/West Wight

4. Parents of Preschool only:Does your child wear a nappy? Yes/No

Parents of all children:May we give your child a drink? Yes/No/Own provided

May we give your child a plain biscuit? Yes/No

5. Medical Information

Does your child have any of the following which may affect their activity?

Medical conditions Yes/NoAllergies Yes/No

Regular medication Yes/NoDietary needs Yes/No

Additional Needs Yes/No

If you answered 'yes' to any of the above questions, or if there is any other information you feel your child would benefit from us knowing,please give details below, or ask to speak in confidence to the Kids Site Lead. Some examples of things that would be helpful for us to know are – if your child has a phobia, has SEN support at school, is in foster care, is experiencing family separation, or bereavement. Please continue on separate paper if necessary.

6. Additional Information

Name of school/nursery (if attended):

7. Consent

I give permission for______to take part in the normal activities of Kerith Kids. I understand that separate permission will be sought for certain activities and outings lasting longer than the normal meeting times of the group(s). I understand that while involved they will be under the control and care of the group leader and/or other adults approved by Kerith Community Church’s leadership and that while the staff in charge of the group will take all reasonable care of the children, they cannot necessarily be held responsible for any loss, damage or injury suffered by my child during, or as a result of, the activity.

I agree to collect my child using the security sticker. In the event that I am unable to collect them, I will pass the security sticker to a nominated adult who is known to my child.

Signed(parent/adult with parental responsibility):

Name in block capitals:

Relationship to child:

Date: