Childs Full name:         Male:     Female

Date of Birth:                 School:
Parent/Guardians Full name
Home address

Phone number

I give Permission for my child's details to be entered on the Church database
I give permission for my child's photograph to be taken during the club and published on www.emmanuelbarnsley.co.uk website                                                                          
Do you wished to be contacted about future events at Emmanuel? Please give us your email address: