After School Club Registration Please complete the registration form below prior to attending. 2022 After School Club Registration About You Are you a Parent, Guardian, Carer or Registered Child Minder? * Please Choose:ParentGuardianCarerRegistered Child Minder Name * Name First First Last Last Email Main Contact Number * Emergency Contact Number * Please provide for use only in an emergency Address * Address Address Address Town Town County County Postcode Postcode Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Children Number of Children * 1234 Child 1 Child Name * Child Name First First Last Last Date of Birth * Special Needs / Allergies * Please state NONE there are no special needs or allergies. Child 2 Child Name * Child Name First First Last Last Date of Birth * Child 2 Special Needs / Allergies * Please state NONE there are no special needs or allergies. Child 3 Child Name * Child Name First First Last Last Date of Birth * Child 3 Special Needs / Allergies * Please state NONE there are no special needs or allergies. Child 4 Child Name * Child Name First First Last Last Date of Birth * Child 4 Special Needs / Allergies * Please state NONE there are no special needs or allergies. Optional Photo Consent INTERNAL USE: With your permission, we occasionally like to take photos of our fun group activities and place them on notice boards in the Whitton Life Cafe.. Photo Internal Consent * I consent I do not consent EXTERNAL USE: With your permission, we occasionally like to take photos of our fun group activities and publish them in our newsletter, website & Facebook page. Photo External Consent * I consent Required First Aid Consent FIRST AID: We require your permission to carry First Aid in the event of an accident in your absence. First Aid Consent * I consent I do not consent Privacy Policy We collect and use this information to: Enable the Whitton Life to run children & young person events safely. Ensure we can contact you or nominated contact in case of emergency. Inform you of changes to our events. Send you updates regarding After School Club and other Children & Families activities and events at LRBC Data Protection legislation allows us to process the information provided as we regard it as being in the church’s legitimate interest. It is with great regret that we are unable to include your child if you are unable to provide the information requested. For more information about how we hold your data and your rights under data protection legislation please email office@londonroad.org.uk or visit https://londonroad.org.uk/privacy-policy/ If you are human, leave this field blank. REGISTER
