© 2019 by Xpression Portadown . 

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UNDER-18 SIGN-UP FORM

Make sure a guardian/parent is present when filling this out!

GENERAL INFORMATION

PARTICIPANT DETAILS

PARENT/GUA DETAILS

EMERGENCY CONTACT

EMERGENCY CONTACT 1

EMERGENCY CONTACT 2

GP INFORMATION

PLEASE LET US KNOW OF ANY MEDICAL OR OTHER INFORMATION:

XPRESSION INFORMATION

T-SHIRT SIZE
KIDS CLUB
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I have experience working with children

WEEKLY
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i am willing to help with kids club

FRIENDS I WOULD LIKE TO SERVE WITH.

PARENTAL STUFF!

I CONFIRM THAT ALL DETAILS DECLARED ARE COMPLETE AND CORRECT TO THE BEST OF MY KNOWLEDGE. 

in the unlikely event of an accident, I give permission for a trained first aider to treat my child.  in an emergency were I or an emergency contact cannot be contacted: I give permission for my child/ward to be given hospital treatment including aesthetic if necessary.  I understand that every effort will be made to contact me.

photographs will be taken for publicity purposes.  should you wish your child's/ward's photo not be taken please tick here

I consent to the storage & use of my child/ward's email for the use of communication relating to events within xpression. 

This email acts as a Digitial Signature, by entering it and submitting the form this will be taken in good faith as the required permission needed to partake in Xpression.