Hallelujah Night Registration Form

Choose Event *

There are currently no events available for registration.

Child's Personal Details

First Name *

Date of Birth *

Gender

Last Name *

Age *

Parent/Guardian's Details

Mother's Name

Home Address

Phone Number (evening)

Email Address

Mobile Number

Are you a Partner of Ruach

Yes

Father's Name

Home Address

Phone Number (evening)

Email Address

Mobile Number

Are you a Partner of Ruach

Yes

Health Details

Please give details of any medical conditions about your child that we should know about (e.g. Asthma, Hay fever, Sickle Cell, hearing or vision difficulties etc):

Special Needs

Please give details of any special needs or learning difficulties:

Emergency Contact

Name and address of a relative/guardian who should be contacted in an emergency

Emergency Full Name *

Emergency Address *

Emergency Number *

Emergency Mobile *

By ticking the 'Yes' box, I can confirm that I am the parent or legal guardian of the child named above and that all the information I have provided is accurate *

Yes

I Consent to Ruach City Church using the information on this form for the purpose of the Hallelujah Night Registration process: *

Yes

Name *

Date *

Marketing Permission

Ruach City Church will use the information you provide on this form to be in touch with you and to provide updates and marketing. Please let us know all the ways you would like to hear from us:

Email *

Yes

Telephone *

Yes

Direct Mail *

Yes