Parental Consent Form

Anything written on this form will be held in confidence. The leaders need to know these details in order to meet the specific needs of your child.

Name of organisations attended (tick all that apply)*

Child / Young Person's Name*

First NameLast Name

Date of birth*

DayMonthYear

Home address (inc postcode)*

Name of GP*

GP Practice and Telephone no.*

Name of Parent/Guardian *

First NameLast Name

Phone number in case of emergency*

Second contact's name*

First NameLast Name

Relationship to child

Second contact no.*

MEDICAL

Please indicate medical conditions, additional needs, allergies, or dietary requirements relevant to your child, any medication being taken and anything else that would be helpful for the leaders to know about:

Will he/she carry the medication?

YesNo

If unwell, can they administer the medication themselves

YesNomore details

In the event of a medical emergency, leaders will try to contact you as soon as possible using the contact numbers provided. In the event of illness or accident, having parental responsibility for the above named child, I give permission for first aid to be administered where considered necessary by a first-aider, if available, or medical treatment to be administered by a qualified medical practitioner*

YesNo

PHOTO CONSENT

Do you give permission for photographs/videos to be taken of you child and used for church purposes eg powerpoint display during service?*

YesNo

Do you give permission for photographs/videos to be taken of you child and published in local newspapers?*

YesNo

COMMUNICATION

Leaders may use methods of communication to get in touch about activities and updates within organisations. If you are happy to receive updates via a WhatsApp group, please provide your mobile number below.

Parent/Guardian Name & Mobile number

This applies ONLY to Year 8 + / teenagers (consent for communication). Leaders may communicate directly with the young person through mobile texts and WhatsApp groups for the purpose of arranging activities

I give permissionI do not give permission

The young person knows that mobile phones/electronic devices are not to be used during activities and at no time are they permitted to take photographs*

Young person is aware

Name & contact number of young person. This applies ONLY to Year 8 + / teenagers

Date*

Date

I certify that the information provided is correct and true to the best of my knowledge*

Yes

Type your Name below:*

Parental Consent Form 2024/25