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ACTIVATE ANNUAL CONSENT FORM (ONLINE FORM)

September 2011-2012.

 

Dear Activate Member and Parents,

Please read and complete the following form carefully.

This ensures that all information is up to date and correct and that we have parental permission for your child to attend the club.

 

NAME 

 

 

 

 

 

AGE

ADDRESS

 

 

 

 

 

 

 

TEL NO.

 

MOBILE NO.

ANY MEDICAL CONDITION

 

 

 

 

 

 

ANY OTHER INFORMATION YOU THINK WE SHOULD KNOW

 

 

 

 

E-mail address

 

 

 

May we use photos/videos of your child for our new web-site.

             YES/NO 

(Please delete as required)

We now have CCTV in our buildings for the safety of your children and Activate property.

 

I give permission for my child to take part in normal Activate activities and events, both at the clubhouse and in the adjacent locality and on occasional trips. (A separate form for these trips will be sent out, however).

 

Signed……………………………………….Parent/Carer.               Date……………

 

Please delete one of the following.

I will arrange for my child to be collected after club night/ I am happy for my child to get themselves home.

 

Signed………………………………………Parent/Carer.                Date……………..

 

 

 

Established with the support of:

Hastings Bexhill & Rye Methodist Church : Rother Police : Education Authority : Parish Church : National Lottery

Registered Charity Number 1087115

 

 

 

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