* First Name:

* Last Name:

* Date of birth (DD/MM/YYYY):

* Email address:

* Parent name:

* Parent phone number:

* Parent email address:

As the parent I give permission for the Parish of Hornchurch to contact this person regarding Safari and Safeguarding in any way.

* Address 1:

* Address 2:

Address 3:

* Post code:

* Home phone number:

* Emergency phone number:

T-shirt size: None Small Medium Large Extra Large

(Please only select a T-Shirt size if you are a new leader or if your current T-Shirt is no longer fit for purpose.)

Passport sized photograph:

Please supply a passport size photograph with this form for your Safari ID card (1MB limit - jpeg (*.jpg) format)

Medical conditions:

First aid certificate?

Indicate what type of role are your registering for:

Select days

If you are able to be flexible about the Age Group you work within, please tick more than one Age Group.

Please note no parent will be allowed to work in the Preschool group if they have a child in this group.

* Please tick appropriate boxes (minimum 2 days)

If you have ticked only part of the week but can be flexible about which days you volunteer, please add details below.

Do you want to register your own children for Safari?

Before an appointment can be confirmed a satisfactory Enhanced Disclose from the Criminal Records Bureau must be obtained. Please tick here to indicate your consent.

We would like to keep in touch about Safari and to invite you to future events. Please tick one or more of the boxes to say you consent to us contacting you using the data you have provided. You may unsubscribe at any time by emailing the parish office on office@parishofhornchurch.co.uk.