St. Swithin’s Kids

Thank you for allowing your child to be part of St. Swithin’s Kids. To provide your child with the following, we would appreciate your help with completing this form:

A SAFE AND HEALTHY ENVIRONMENT by having all up-to-date information in case of emergency and by being aware of any medical conditions relating to your child.

Individual development by placing your child in the relevant small group according to their age and individual needs. 

A fun Place to be by keeping you up-to-date with all the latest fun activities.

Child's Name *
Child's Name
Parent/Guardian Name *
Parent/Guardian Name
Has the above named child ever had a reaction to penicillin? *
If yes, please give details below.
Does he/she suffer from any allergies? *
Does he/she carry any medication that needs to be taken regularly? *
Does he/she suffer from a medical condition or illness requiring regular treatment? *
In an emergency and/or you are not contactable are you willing for your child to receive doctor or hospital treatment including anaesthetic? *
Consent *
I agree that the above named child may take part in the group above and related activities organised by St. Swithin’s Church including any organised trips. I understand that while involved, he/she will be under the control and care of the group leader, and/or other adults approved by the PCC, and that, while the staff in charge of the group will take all reasonable care of the children, they cannot necessarily be held responsible for any loss, damage or injury suffered by my child during, or as a result of, the activity. I agree to this information being stored and kept on file. (It will be kept confidential but may be used in an emergency to give information to medics etc).
The above named child may be photographed/filmed for external use (e.g. local newspaper etc) *
The above named child may be photographed/filmed for church use & publicity. *
The above named child has permission to go to and from groups or activities unaccompanied. *
Please type your full name as your signature