CHILDREN'S LITURGY FORM

CHILDREN'S LITURGY 2025/26
CHILD AND GUARDIAN JOINT CONSENT

(Please complete this form for each child attending the Children's Liturgy and let us know if there are any significant changes)
Details of Children's Liturgy Group
Name of Group Children’s Liturgy Group
Time of Activity During 11:30am Sunday Mass
Duration 28 September 2025 to 21 June 2026
Organiser Brenda Webb
Details of Child Attending Children's Liturgy
Name of Child *
Name by which the child is known *
Date of Birth*

DayMonthYear
Address of Child Attending Children's Liturgy*
Parent/Guardian Contact Details
Parent/Guardian Name*
Mobile Phone Number*
Relationship to Child*
Landline Number (If applicable)
Additional Responsible Adult

In case of an emergency
Name of Additional Responsible Adult *
Mobile Phone Number*
Relationship to Child*
Landline (If Applicable)
Other Relevant Information
Please provide details of any regular medication, medical condition (e.g. asthma, epilepsy, diabetes, allergies, dietary needs) or disability which may affect normal activity. If your child has no medical conditions listed above, please enter 'Not Applicable'*
Please note: The organisers cannot administer any medication or intimate care, please discuss this with the organisers who will work with you to establish how your child can be accommodated, according to the relevant Policies and Procedures.
In the event of a medical emergency

In the event of illness or an accident, I give permission for medical treatment to be administered to my child, where considered necessary, by a suitably qualified medical practitioner and/or hospital. I understand that every effort will be made to contact me as soon as possible. In an emergency, I can be contacted at the telephone numbers provided on this form.
Parent / Guardian Consent In The Event Of A Medical Emergency. Please sign in the box below.*
Consent Of Child Attending Children's Liturgy
I (child named below) would like to take part in the Children's Liturgy.*

First NameLast Name
I understand that photographs may be taken during the group activities*

I have discussed this issue with my child and he/she HAS GIVEN their permission for photographs taken during group activities to be used in any hard copy or online publications by the Parish or DioceseI have discussed this issue with my child and he/she HAS NOT GIVEN their permission for photographs taken during group activities to be used in any hard copy or online publications by the Parish or Diocese
I understand that videos (which may include webcam) may be taken during the group activities. Please be advised that the Parish Webcam is streaming 'Live' images during the 11:30 am Mass on Sundays.*

I have discussed this issue with my child and he/she HAS GIVEN their permission for videos (which may include webcam) taken during group activities to be used in any hard copy or online publications by the Parish or Diocese.I have discussed this issue with my child and he/she HAS NOT GIVEN their permission for videos (which may include webcam) taken during group activities to be used in any hard copy or online publications by the Parish or Diocese.
Code of Behaviour*

I understand that during group activities I will be appropriately supervised at all times and I agree to abide by the group’s code of behaviour.
Code of Conduct for Children attending of Children’s Liturgy
Parental / Guardian Consent
I agree to allow the above-named child to attend the Children's Liturgy Group held during the 11:30 am Sunday Mass between 22 September 2024 and 22 June 2025
Signature of Parent / Guardian*
Supervision and Code of Conduct
Agreed Code of Behaviour*

I understand that there will be suitable supervision and an agreed code of behaviour whilst my child IS in the care of the organisers.
Code of Conduct for Children attending of Children’s Liturgy
Refusal of consent for use of photographs/video. Please be advised that the Parish Webcam is streaming 'Live' images during the 11:30 am Mass on Sundays.

Please tick this box ONLY IF YOU DO NOT wish photographs/video (which may include webcam) to be taken of your child otherwise leave blank
Signature of Guardian / Parent*
CODE OF CONDUCT

Please read and agree the Code of Conduct at the bottom of this section
Mission Statement
We aim to bring children close to the Word of God through prayer, discussion and activities.
Code of Conduct for Volunteers
Code of Conduct for Children Attending Children's Liturgy
DATA PROTECTION

In accordance with the Data Protection Act 2018
Diocese of Down and Connor Interim Child Protection Policy

These codes of conduct are based on the recommendation of the Diocese of Down and Connor interim child protection policy. If you wish to view this policy, or have any queries or concerns, please contact the Parish Office on 028 437 22401 or the Parish Safeguarding Committee on 07840028461.
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CHILDREN'S LITURGY 2025/26

CHILD AND GUARDIAN JOINT CONSENT

Details of Children's Liturgy Group

Details of Child Attending Children's Liturgy

Parent/Guardian Contact Details

Additional Responsible Adult

Other Relevant Information

In the event of a medical emergency

Consent Of Child Attending Children's Liturgy

Parental / Guardian Consent

Supervision and Code of Conduct

CODE OF CONDUCT

Mission Statement

Code of Conduct for Volunteers

Code of Conduct for Children Attending Children's Liturgy

DATA PROTECTION

Diocese of Down and Connor Interim Child Protection Policy