RICKSTONES CHURCH, WITHAM
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Contact us
Home
About us
What we believe
Who's who
Our vision
Our community & world
What's on
Sundays
Home Groups
Children & Families
Foyer Cafe
Let's Do Lunch
Upcoming events
Listen online
Contact us
About your child
*
Indicates required field
Child's name
*
First
Last
Date of birth
*
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January
February
March
April
May
June
July
August
September
October
November
December
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2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
Address
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Which school will your child be attending in September 2018?
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Please tell us if your child suffers from any allergies
*
Please tell us if your child has any behavioural problems, learning difficulties, disabilities etc
*
Please tell us if there is anything else you think we should know about your child
*
Parent/guardian details
Name
*
First
Last
Email
*
Phone number
*
Your relationship to the child
*
Emergency contact details
If we're unable to contact the named parent/guardian, who should we call?
*
First
Last
Their phone number
*
Their relationship to the child
*
Attendance & Collection
Will your child be attending all 5 days at Holiday Club?
*
Yes
No
If NO, which days will he/she be attending?
*
Monday
Tuesday
Wednesday
Thursday
Friday
If your child is under the age of 9, he/she must be collected by an adult. If he/she is not going to be collected by a parent/guardian, you must inform the group leader who will be collecting your child instead. If your child is aged 9 or above, you may tick the box below to give permission for him/her to go home alone.
*
I give permission for my child to go home alone. I understand that if he/she leaves the premises of his/her own accord before the scheduled end of the session, he/she ceases to be under the responsibility of the group leaders.
Photography
We may take photographs during our events, some of which may be used for promotional purposes. These photographs may be put on our website or used in presentations. Please tick the box ONLY if you DO NOT wish your child to be in any photographs that we take.
*
I DO NOT want my child to appear in any photographs taken at Rickstones Church.
Consent
Please read the following information before you submit this form.
Activities
Some activities may take place outside the Church buildings (e.g. in the rear car park or the field behind the Church). If possible, these areas will be made secure and, in accordance with our Safeguarding Policy, a suitably number of adults will always be supervising these activities. Some activities may include wet or messy elements. Participation is always voluntary, and if necessary, we will provide protective equipment/clothing for the children taking part.
Behaviour
Disruptive or consistently poor behaviour is normally dealt with by the group leaders. However, such behaviour may on occasion result in action being taken against the individual(s) concerned, such as a temporary or permanent ban, although this is exceptionally rare. All behaviour incidents will be dealt with in accordance with our Behaviour Policy, which you can ask to see at any time.
First Aid
First Aid may be administered, if necessary, by persons trained to do so, in accordance with our First Aid policy. In the unlikely event of an emergency, we will try to contact you. Failing that, we will try to contact the person you have named above as an alternative contact. If we deem it necessary, an ambulance may also be called.
Safeguarding
We take Safeguarding very seriously. You can ask at any point to see our Safeguarding Policy. All our group leaders are DBS checked.
Please check the boxes to give your consent.
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I have read the information above and accept them as the conditions set out by Rickstones Church.
*
I consent to my child attending children's groups/activities at Rickstones Church.
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I understand that if I attend a group/activity with my child, then I am responsible for him/her.
Privacy
We have a Data Protection Policy that seeks to comply with all relevant legislation. Please click
here
to view our Privacy Notice (opens in new window).
We would love to be able to contact you by email about other events/groups that you may be interested in. Please tick the box if you are happy for us to contact you in this way.
*
I am happy to be contacted by email about any other events/groups organised by Rickstones Church.
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