BUSY Permission Form 2022
Young Person Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
School Year
Emergency Contacts
Parent/Guardian Name
First Name
Last Name
Email
example@example.com
Relationship to Young Person
Phone Number
Please enter a valid phone number.
Name of extra Emergency Contact (in case we can't get in touch with you)
First Name
Last Name
Relationship to Young Person
Phone Number
Please enter a valid phone number.
Young Person Phone Number
If you consent, we can text your child a reminder of when their youth group is, any cancellations and activity related information. This is helpful in these changeable times, especially in the case of us having to move youth group back online. We will not use text for pastoral interactions, just to relay group information. Providing the number acts as consent for us using it.
Young Person Phone Number
Please enter a valid phone number.
Health Information
Does your Child have any Allergies?
Yes
No
If Yes, please give details of the condition and any medication.
Does your Child suffer from any other Medical Conditions we should be aware of?
Yes
No
If yes, please give details and information about any medication.
Covid-19
I agree not to send my child to a BUSY activity if they have been unwell or off-school.
Yes
No
I have spoken with my child, to remind them that, unlike school, social distancing rules are in place at youth group.
Yes
No
Photographs
I give permission for photographs of my child to be used in BUSY publicity, such as leaflets and the website.
Yes
No, thank you.
Submit
Should be Empty: