Child's First Name:
Date of Birth: School Year (as of September 2020):
Emergency Contact Numbers
1. Name of Contact: Relationship to child:
2. Name of Contact: Relationship to child:
Please give details of anything we need to be aware of:
Medical Conditions (e.g. Asthma)
Allergies/Dietary (e.g. Hayfever)
Behavioural needs to be aware of (e.g. Autism, ADHD)
Permission to Attend Kids Club
I give permission for my child to attend Kids Club on Fridays, which may include visits to Cheam Park (weather permitting).
How Cheam Baptist Church handles information about you and your child.
Information about you and your child in this form will only be used for keeping a record of and managing your child’s involvement with Kids Club. This information will be kept confidentially and securely, and may be disclosed outside of CBC but only with your consent, or if there is a legal requirement, and with appropriate safeguards.
Information on this form will be kept on CBC’s records only whilst your child attends Kids Club and will be deleted from CBC’s records as soon as possible after your child ceases to attend.
Photographs/video footage of my child may be used in displays in the church buildings, in presentations of the church children’s work or on the church website.
You have the right to withdraw your consent to CBC’s handling this information at any time, a free right of access to any information about you kept by CBC, the right to have information about you kept by CBC deleted, corrected or restricted to a specified purpose at your request, and the right to complain to the UK Information Commission if you believe that CBC has misused any information about you.
I give permission for information about me and my child to be handled by CBC as outlined above.
If you have any questions please contact Nic Bianchi by
telephone: 020 8642 5070.