Diocese of Chelmsford “Pool, Praise & Party” Registration Form Everyone under the age of 18 attending the PPP Event must bring a signed copy of this form along on the day

Name: ______

Date of Birth: _____/_____/_____ Age: ______

Address: ______

______Postcode: ______

Medical Conditions: ______e.g., “asthma”, “epilepsy”, and a brief summary of the action you would like us to ______take if the condition manifests itself (e.g., “phone us immediately”, “self-medicates”) Allergies: ______Please include brief instructions on what you would like us to do if your child ______displays signs they are having an allergic reaction (e.g., “administer epipen”) Additional Needs: ______Let us know anything else that will help us make the activity the best it can be for your ______child (e.g., “Diagnosed with ADHD” or “struggles with fine motor skills”)

Emergency Contact 1 Name & Number: ______

Emergency Contact 1’s Relationship to the Child: ______

Emergency Contact 2 Name & Number: ______

Emergency Contact 2’s Relationship to the Child: ______

Parent/Carer’s Email Address Where Available: ______

Agreements Please tick all that apply: ⃝ I agree photographs/video of my child can be used by the Diocese of Chelmsford for promotional purposes

⃝ I would like to be contacted about other Diocesan Events in the future

Permission I give permission as the parent/carer of the child named above for them to take part in the PPP Event on 21 st June 2015

Signed: ______Print name in block capitals: ______Date: ___/___/___

Additional Permission for Use of the Swimming Facilities Young people aged 14-18yrs can book in for a 45 minute slot during the afternoon in the Bishops Court pool. We require all parents/carers of children who would like to take part in this to confirm that their son/daughter is a competent swimmer. Remember to bring a towel! ⃝ I confirm that my son/daughter is a competent swimmer and has my permission to take part in a swimming session during the event. ⃝ I confirm that both parent/carer and young person have read and agreed to abide by the attached behaviour policy .

Luke Lowrie, Youth Worker 02085083643 (10-12 Mon-Thurs) St. Mary’s Church 07740346187 (All times) High Road, Loughton [email protected] IG101BB www.stmarysloughton.org.uk Luke Lowrie, Youth Worker 02085083643 (10-12 Mon-Thurs) St. Mary’s Church 07740346187 (All times) High Road, Loughton [email protected]

IG101BB Pool Rules for ‘Pool, Party & Praise’ 21st June 2015 www.stmarysloughton.org.uk

 We expect a high standard of behaviour from our swimmers both in the water and on poolside premises.

 We ask that swimmers must show respect to the other swimmers, the lifeguard and the pool/ facilities to which you have been kindly given permission to use free of charge at the event.

 Swimmers will not be allowed to enter the pool until the lifeguard has given permission and must leave the pool when the lifeguard announces that their time slot has finished.

 Parents/carers are responsible for their children at all times including their safety and behaviour throughout the event, including whilst swimming. If at any time a young person appears to be unsupervised while making use of the pool facilities, or if their behaviour is judged to be unacceptable by the Lifeguard or Time for Youth Team, they will asked to leave the pool.

 Only competent swimmers between the ages of 14-18yrs old are allowed to swim at this event and signed permission slips must be bought along on the day or they will not be allowed to enter the pool area.

Please could all swimmers make sure they wear appropriate swimwear.

 While in the Pool:

o No running or diving

o No ducking or pushing people into or under the water

o No acrobatics or gymnastics

o No fighting or bullying

o No swearing or spitting

o No standing on or jumping onto floats

Luke Lowrie, Youth Worker 02085083643 (10-12 Mon-Thurs) St. Mary’s Church 07740346187 (All times) High Road, Loughton [email protected] IG101BB www.stmarysloughton.org.uk