Wee Disciples Registration Form

Childs Name *

Date of Birth *

Home Address *

Child's special interests? *

Any Allergies/Medical Conditions *

Emergency Contact Information *

I will probably be at Church for the duration

OTHER - Please fill out next section

OTHER CONTACT INFORMATION *

From time to time we may take pictures or images of the children to publicize church events e.g. for use in brochures, local press, social media etc. Please indicate below whether you give permission for us to do this in relation to your child. *

I do give permission for my child's image to be used in this way

I do give permission, but would prefer my childs face not seen

I do not give my permission for my child's image to be used in this way

I confirm i am digitally signing this document as the parent/guardian of the child *

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Wee Disciples Registration Form

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