Summer Together

To register your child for the Summer Together Activities, please fill in form below.

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Child's name *

First

Last

Date of birth

School *

Primary at June 26 *

Do you wish to register another child?

no
yes

Child's name *

First

Last

Date of birth *

School *

To help us with numbers, please let us know which days your child/children plan to attend

Every Tuesday
30th June
7th July
14th July
21st July
28th July
4th Aug

Primary at June 26 *

Doctor's Name

Doctor's Phone

Allergies or Medical Conditions

Additional support needs- in order to support every child to enjoy our Summer Together activities, please detail any additional support needs so we can plan appropriately and we will endeavour to support

Home Address *

Address Line 2

Town/City *

Postcode *

Parent's/Guardian's Name *

First

Last

Phone *

Email *

Alternative Emergency Contact Name *

First

Last

Phone *

Email *

My child (children) may be collected by

Parental Consent - In the event of illness or accident, I give permission for any necessary medical treatment to be given by the nominated first-aider. In an emergency and if I can't 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

Photographic permission - please let us know if you are happy for us to use photos of your child taken at Summer Togetherto be used for this church's publicity ( including our Facebook page). Photos will always be respectful in their nature with no link between your child's image and their personal details. *

yes
no

We would like to send you information regarding future events at Stirling North

yes
no

Date *

The information supplied on this form will be kept securely by our church on a database and only used for church related activities. It will not be disclosed to any third parties. Our privacy policy can be viewed our church website (stirlingnorth.org). You can withdraw consent at any time by contacting our Data Protection Officer (info@stirlingnorth.org)