4th Seed Booking & Consent Form

4th Seed Booking & Consent Form
When: Usually first Saturday of each month, 7.30-9.30pm
7 September, 5 October, 2 November, 7 December

Where: The Faith Mission Centre, Durrow, Co.Laois

What: A themed Bible study and related activities, pool and table-tennis, occasional crafts and games, food.

Who: For those aged 6th class to 3rd year

How: To book a place, parents must fill in the booking and consent form. Reminders and updates will be sent out by Whatsapp.

How Much: There is no charge for the evening.

Organised by Mervyn & Rachel Tomb of The Faith Mission.
Name of Young Person*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Email*

Confirmation Emailexample@example.com
Parent's Mobile Phone Number*
Emergency contact, if parent is unavailable*
Name and mobile number
Details of any known conditions, allergies (Eg asthma, diabetes epilepsy) and medications being taken
Any other special needs, requirements which we should know about.
Consent
I give permission for my data to be stored by the Faith Mission for notification of future events.*

Consent
View Our Privacy and Data Policies
In the event of illness or accident, I give permission for first aid to be administered where considered necessary by a trained first aider, if available, or medical treatment to be administered by a suitable qualified medical practitioner.

If I cannot be contacted and my child should require emergency hospital treatment, I authorise an adult leader to sign on my behalf any written form of consent required by the hospital. However I understand that every effort will be made to contact me as soon as possible.
During the event, photographs may be taken for publicity purposes. They may be used on The Faith Mission Website. On signing this form we assume that you have given permission for your child's photograph to be taken.*

Consent to all the above
Signature

Clear
Parent or Guardian's Name*

First NameLast Name
Should be Empty: