KICK registration form 5-10 Years

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Dear Parents,
Thank you for taking the time to fill out this registration form. Any personal data collected in this form will be kept safe and secure under the terms of the privacy agreement and GDPR held at Church180 Elim and by Elim churches.
This form is to be completed for any child attending KICK. KICK is for children aged between 5-10 years. If your child is older we have a youth group available as well. Please go to our youth page to find the link to GeNext 180 Youth Registration form.
KICK runs every Friday night 6:30-8:00pm (term time.) We have a jam packed programme of games, crafts, songs and teaching.

Contacts:
Website : www.church180.co.uk/
Facebook : @Church180Elim
Instagram: @Church180elim
Phone : 01803 528592
Address: Church180, Hodson Close, Paignton, TQ3 3NU (Car park available)

Name of child *

Date of Birth *

YYYY

Address *

Emergency Contact Name *

Emergency contact number *

Emergency contact name 2

Emergency contact Number 2

Email Address *

Are there any additional needs we need to know about? (Inclu. health, allergies, dietary and learning) *

I give consent for my child to have their photos taken during any clubs at Church180 *

I give consent for my child to have their photos published at the church’s discretion *

I give my permission for my child to have face painting *

Transport

As part of KICK we provide a mini bus transportation service to those living in Foxhole and QED area. If our Mini bus is full we may use car transportation. All of our vehicles are fully serviced and have the correct insurances in place to carry children.
We have a few pick up points around the area. Please select the one closest to you for pick up and drop off. Only children who are registered and have consent will be able to travel on the bus.
We do not pick up and drop off children to their homes. Please make sure there is an adult with your child at the bus stop waiting unless there is consent for the child to walk home alone.

I agree to let me child travel on the transport provided by Church 180 *

Yes

No- I will drop off and collect my child from Church 180

Please select the bus pick up point you would like us to collect and drop off your child

Please select the following consent for before and after bus journeys.

I will drop off and collect my child from the bus stop

I give consent for my child to walk to the bus stop and walk home alone

Clear selection

Club expectations

Please read the below expectations with your child:

• Respect Leaders and all other people
• Respect the building inside and outside
• Do what the leaders and volunteers ask of you
• No play fighting
• No swearing
• Bullying is not tolerated- This includes any form of physical, psychological, emotional, verbal or online abuse!
• No drugs, alcohol or energy drinks.
If Children and young people consistently do not follow the above expectations you may be asked to come and collect your child or asked to leave the premises. Parents will always be contacted if this occurs. They may subsequently be asked not to attend the following session/s. If this continues to happen over a period of time there is a possibility that they may no longer be able to attend.

I have read the above expectations and understand

I understand that if my child is in need of first aid while at Church 180 or on transport that first aid will be carried out by a qualified first aider.

I have filled out this form to the best of my knowledge

Required

Parent Signature *

Date *

YYYY

Submit

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