Secret Signup Page For Leaders

Hey, this form is for those who may be a little bit late signing up for the weekend… Please don’t share this page with anyone, thanks 😃

    Leader Details

    First Name

    Last Name

    Date of Birth

    Church

    Email Address

    Telephone Number

    Leader Address

    Address Line 1

    Address Line 2

    City

    Postcode

    Emergancy Contact

    First Name

    Last Name

    Telephone Number

    Medical Details

    Is medication required? If so, please state type & dosage

    Please describe medication required

    Does this camper have any aditional care needs?

    Please describe additional care needs

    Does this camper have any alergies

    Please describe alergies

    Does this camper have any dietary requirements?

    Please describe dietary requirements

    Doctor Details

    Doctor Name

    Doctor Phone Number

    Doctors Address

    Address Line 1

    Address Line 2

    City

    Postcode

    Data

    I agree that by submitting this form my data will be processed in accordance to Ebenezer Chapel's Data Policy, a copy of which can be found at EbenezerChapel.org.uk/Policies.

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