Easter Eggstravaganza 2023 - Parental Consent Form

Rutherglen Stonelaw Church Easter Eggstravaganza

Parental Consent Form
Children's Details

Please complete for your child / children
How many children would you like to register*

1234
First Child's Name*

First NameLast Name
Sex*

MaleFemale
Date of Birth*

DayMonthYear
School Year (August 2022 - June 2023) (or select 'Not yet at school')*
Please note, children not yet at school must attend with an adult
Second child's name*

First NameLast Name
Sex*

MaleFemale
Date of Birth*

DayMonthYear
School Year (August 2022 - June 2023) (or select 'Not yet at school')*
Please note, children not yet at school must attend with an adult
Third child's name*

First NameLast Name
Sex*

MaleFemale
Date of Birth*

DayMonthYear
School Year (August 2022 - June 2023) (or select 'Not yet at school')*
Please note, children not yet at school must attend with an adult
Fourth child's name*

First NameLast Name
Sex*

MaleFemale
Date of Birth*

DayMonthYear
School Year (August 2022 - June 2023) (or select 'Not yet at school')*
Please note, children not yet at school must attend with an adult
Do any of the children registered have known Additional Support Needs?*

YesNo
Please indicate Additional Support Needs *
Parent / guardian's details
Name*

Mr/Mrs etcFirst NameLast Name
Parent/guardian's address details*

Address Line 1

Address Line 2

Address Line 3Address Line 4

Postcode
Parent/guardian's email address*
example@example.com
Parent/guardian's contact numbers*

Main contactAlternate contact
Emergency contact during Easter Eggstravaganza
Name

First NameLast Name
Phone Number

Area CodePhone Number
I authorise only this person to collect my child / children

First NameLast Name
GP's Name

First NameLast Name
GP's Phone Number

Area CodePhone Number
In the unlikely event of illness or accident I give my permission for any appropriate first aid treatment to be given by the nominated first aider. In an emergency, and if I cannot be contacted, I give consent for my child to receive treatment by a GP and/or hospital, including treatment under general anaesthetic. I understand that every effort will be made to contact me as soon as possible.
I give my permission
I am happy to receive information about future events which may suit my child / children*

YesNo
Photographs may be taken during the event for Church publicity purposes (local newspaper, church website etc.) No child will be individually identified. Please indicate your preference below*

No, I do not want photographs of my child / children takenYes, I am happy for photographs to be taken of my child / children
Parent/Guardian's Consent

By submitting this form, I give permission for my child to attend this event at Rutherglen Stonelaw Church. I confirm that the details are correct and complete to the best of my knowledge. In the event of illness or accident, I give permission for any necessary medical treatment to be given by the nominated first-aider. In an emergency and if I can’t be contacted, I am willing for my child to receive hospital treatment, including anaesthetic, if necessary. I understand that every effort will be made to contact me as soon as possible. We promise to look after your data in accordance with General Data Protection Regulation. If asked by NHS Test & Protect to provide contact details of young people who attended an event, we will do so.

Stonelaw Church is registered as a charity (SC013558).
Please verify that you are human*
Should be Empty:

Rutherglen Stonelaw Church Easter Eggstravaganza

Children's Details

Parent / guardian's details

Emergency contact during Easter Eggstravaganza