Membership Signup Form

This membership form must be filled out by a parent/guardian (aged 18+) of the child registering.

Since 1971, Hayes Town Chapel Youth Club has been well attended and enjoyed by many local children. We believe that the following form is necessary for the Youth Club to remain successful and enjoyable for all. Fields marked in bold are required. We thank you for your co-operation.

Your Child's Information:
(Your child must be aged 11-16)

First Name:

Last Name:

Date of Birth: Year 2000 1999 1998 1997 1996 1995 1994 1993 1992 Month January Febuary March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Address (line 1):

Address (line 2):

Town:

County:

Postcode:

Telephone No.:

Mobile No.:

Email:

Does your child have any special dietary requirements:

Please make us aware of any allergies your child suffers from:

Does your child have any medical conditions that you would like us to know about:

Is there anything else you'd like us to know that would help us to care for your child:

Parent/Guardian's information:
(These contact details will be used in the case of an emergency)

First Name:

Last Name:

Relationship to Child:

Telephone No.:

Mobile No.:

Please read the following rules and conditions of Hayes Town Chapel's Youth Club. To maintain a friendly environment for games, activities and to provide an opportunity for children to learn about the Christian faith, these are the rules which all the children are expected to adhere to at all times whilst attending the Youth Club.

Rules:

1. Children are registered and subs collected on arrival after 7:30pm. Any child deliberately arriving late, thereby missing the Bible study (at 7:40pm) will not be allowed entrance.
2. Foul language and inappropriate conversation will not be tolerated. ie: The misuse of God’s name and the name of our Lord Jesus Christ, swearing and language that is not acceptable.
3. We will allow no physical or verbal harassment of any nature at anytime. If your child should be the victim of this type of behaviour this needs to be reported to a leader immediately.
4. All leaders/helpers are to be respected and obeyed at all times.
5. The equipment and property of the Youth Club is to be respected. Compensation may be required with regards to any costs incurred.
6. No drugs, alcohol, cigarettes, fireworks or weapons are to be brought onto the church premises.

Terms & Conditions:

1. Failing to comply with the above rules will result in the child being warned once only and sent home depending on the severity of the incident.
2. Sometimes children decide to leave early. If your child wishes to leave at any point before closing time at 10:00pm a leader must be notified.
3. The Youth Club is not responsible for your child before they arrive or after they have left the church premises. This also applies when the Youth Club closes at 10:00pm.

Important: By entering your name below, you are confirming you have read and are in total agreement with the above rules, terms and conditions. Your name will be accepted as your personal signature.

Your full name:

Please click to confirm you are over 18 years of age: