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Welcome to Kidz Klub!

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Young Leader Consent Form

Young Person's Name

Young Person's DOB * required

Emergency Contact Name

Surname

Address

Emergency Contact Number

Young Person's Number - to be added to our WhatsApp Community (numbers are not visible to other members)

What church do you attend?

Church or Youth Leader's Name

Any medical details, dietary requirements or SEND that we need to be aware of?

Availability (9am-1pm) * Required

Monday 17th August

Tuesday 18th August

Wednesday 19th August

Thursday 20th August

Friday 21st August

Friday 21st August, 1pm-3pm

Consent: I give permission for my child to... * Required

attend Kidz Klub as a Young Leader.

have his/her photo taken. (These may be used by any church connected to Kidz Klub.)

Your name

Relationship to Young Person

Thanks for submitting!

© 2025

by Kidz Klub Harlow

Kidz Klub is run by churches in Harlow: Harlow Baptist Church is responsible for Kidz Klub but runs events in full partnership with St Mary's, Churchgate Street & Harefield Church.

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