CKERS Youth Group registration form (blank)

CKERS Registration Form
Name……………………..……………………..……………………..……………………..……………………..
Date of Birth……………………..……………………..……………………..……………………..…………..
Name of Parent / Guardian……………………..……………………..……………………..……………
Address……………………..……………………..……………………..……………………..………………….
……………………..……………………..……………………..……………………..……………………..……….
……………………..……………………..……………………..……………………..……………………..……….
……………………..……………………..……………………..……………………..……………………..……….
Phone Number……………………………………………………………………………………………………
Email Address……………………………………………………………………………………………………..
Doctors Name and Address…………………………………………………………………………………
……………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………
Allergies of Medical conditions that we should be aware of
……………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………
School Attended………………………………………………………………………………………………….
I give/do not give permission for …………………….
to walk or cycle home alone after CKERS. (delete as appropriate)
Parent / Guardian signature……………………………………………………………………………….
Date……………………………………………………………………………………………………………………