St John's Youth Club

Please complete this form to register your child for the Youth Club.  This information will be kept in agreement with GDPR and will be destroyed at the end of each academic year. For more information like us on Facebook (St John’s Church, Perry Barr) and follow us on Twitter (@StJohnPerryBarr).

Child/Young Person's Full Name:*
Name by which they prefer to be called:*
Their date of birth:*
Full home address and postcode:*
Does the young person have any medical conditions about which we should be aware?:*
If yes, please state here (e.g. allergies, asthma, epilepsy, travel sickness, diabetes etc):
Please give any details of special dietary needs, if applicable ( or state "none"):*
Emergency contact details: please give telephone number(s), name(s), address(es) and relationship (e.g. parent, grandparent, neighbour) of at least one person we can contact in an emergency:*
Consent: Please type your name and relationship to the child here, as well as today's date, to indicate your consent to their participating in the Youth Club activities.:*
I give permission for my son/daughter’s image (including photographs and videos) to be used on the St John's website or social media platforms:*
Our contact phone number is 07907779814. We would like to contact you with news throughout the year, to be informed about events and other information. Are you happy to join the Youth Group WhatsApp group?:*
Please insert your preferred phone number for the WhatsApp Group here:
If you ticked NO, how would rather be contacted?:
Text message
Please enter the verification number on the right:*
one two two two six
* Required Fields