LiveWires Waiting List 2023-24 • ChristChurch Banstead

Child's Details

First Name *

Last Name *

Gender *

Date of Birth *

Current School Year *

Tip: Please note: LiveWires is only for children in Years 3 to 5. We are unable to accept children outside these years.

Address (Street and Number) *

Address (Town) *

Address (Postcode) *

Please detail any medical condition, allergy, dietary requirements, routine medication, adverse reaction to medication, or special educational needs

Parents' / Guardians' Details

First Name *

Last Name *

Mobile Number *

Email Address *

Home Phone Number (optional)

This Term

By completing this form, I am joining the waiting list for a place for my child at LiveWires this term between Friday 12 April and Friday 12 July (no session on 31 May as half-term).

If my child is no longer able to attend on a Friday evening, I agree to contact the LiveWires team to let them know (see confirmation message for details). If my child is offered a place but does not attend for 3 consecutive Fridays, ChristChurch reserves the right to offer their place to another child for the rest of term.

I confirm I am adding my child to the waiting list for the above dates, and agree to contact the LiveWires team if they can no longer attend *

I agree

Consent of Parent / Guardian

I agree to my child taking part in teaching and activities organised by the leaders of the ChristChurch Banstead children's department. *

Yes

In the event of any emergency, injury or illness, I give my permission for necessary medical treatment to be given, including anaesthetic. I understand that every effort will be made to contact me as soon as possible in the event of an incident. *

Yes

I understand that my child will be under the care of the group leader and/or other approved adults, and while all reasonable care will be taken, they cannot necessarily be held responsible for any loss, damage or injury during or as a result of the group. *

Yes

I give permission for photos and videos that include my child to be taken and used by the church for promotional use. No names will be used alongside photos. *

Yes

I understand that my child should abide by the rules that are set by the leaders of the various groups my child attends. *

Yes

I understand that if my child's behaviour is disruptive then discipline procedures will be followed and that I will be contacted if my child needs to be temporarily excluded from a group. *

Yes

Please note: All our childrens leaders are externally vetted as being suitable to work with young people. In the case of outings, separate permission will be requested. The above details will be stored securely on the church database. We will not share this information with anyone unless required to by law. Your privacy is important to us at ChristChurch. You can read our Privacy Notice at any time at www.christchurchbanstead.org/privacy.

If you would like to occasionally hear from us about future events and groups, please tick the relevant boxes below. Please keep me in touch by:

Signature

Please type your full name in place of your signature *

Please select today's date *