Delve Booking & Consent Form

What: A youth Bible Study, with some games and food as well.

When: Usually second Saturday of each month, 7.30-9.30pm

13 September, 11 October, 13 December, 10 January, 14 February, 14 March, 11 April, 9 May, 13 June.

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

Who: Those in secondary school.

Name of Young Person*

First NameLast Name

Date of Birth*

DayMonthYear

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Contact Email*

Confirmation Emailexample@example.com

Mobile Phone Number*

Used in Whatsapp group

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.

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 son/daughter 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 son/daughter's photograph to be taken.*

Consent to all the above

Signature

Parent or Guardian's Name*

First NameLast Name