MAP Registration Form

Church group : MAP - preschool and reception to year 5 
This group meets between 10 am and 11.15 am on Sunday mornings (usually the second and third Sundays in the month) for learning and participation in projects related to Christianity. It usually meets in the Bell Tower or the Oldham Hall (in which case members walk down to the Hall and back under adult supervision). We also meet for outings now and again, for example to a local farm to feed the lambs in the Spring and Peterley Farm for fruit picking in the Autumn. These meetings/visits are always under adult supervision, prior notice is given to parents and consent requested.

Child's Details 

Name:
Date of Birth:
School:
School year group:

While your child is in our care it would be helpful for us to know whether he or she suffers from any allergies or phobias or is on any medication. Is there any thing else you would like us to know?
Any additional information

Doctor's Name
Doctor's Address	[Doctor's Address]
Doctor's Telephone Number

Parent or Guardian’s Details and Consent

Name:

Address:
Town:
County:
Postcode:
Country:

Telephone:
Mobile:

Email Address:
Name and telephone number of a friend in case of emergencies:	[Name and telephone number of a friend in case of emergencies]

 

My child will be brought and collected from the group by me or another adult	Yes No
My child has my permission to travel to and from the group without me	Yes No
I agree to photographs and short videos of activities including my child to be taken for use within the Church community and for possible publication including newspaper or internet. Children will not be named except with explicit permission	Yes No

By submitting this form, you are electronically signing this form and confirm that the contents are all accurate.