Autumn Soul 2024 - Parental Consent Form

Anything written on this form will be held in confidence. IMYC & the local leader/s need to know these details in order to help meet the specific needs of your child.

Are you filling this in on behalf of a volunteer (eg. Steward) or a child with a group?*

VolunteerChild with a group

Group/Congregation*

Group Leader's Name*

Group Leader's Email*

Participant Details

Child's Full Name*

First NameLast Name

Preferred Name:

Home Address*

Address Line 1

Address Line 2

Town/CityCounty

Postcode

D.O.B*

Date

Age*

Gender*

Parent/Carer Details

Parent/Carer Full Name:*

Relationship To Child:*

Parent/Carer Email Address:*

Best Contact Number:*

Contact Commitment

I agree that I will be contactable by phone at all times during any programmes that my child attends or participates in.*

Yes

Emergency Contact Details

Please note: These numbers must be contactable at all times during programme.*

	Full Name	Relationship To Child	Best Contact Number
2nd Emergency Contact
3rd Emergency Contact

Media Consent

During the time you will be with us, photographs and/or video may be taken. These may be used in print & digital media, for display and/or advertising purposes in various places (social media, YouTube, Irish Methodist & IMYC website, physical print) both during & after the event.

Please let us know if you are happy with this:*

Yes, I give my permissionNo, I do not give my permission

If you do not give us photo/video consent, please upload a photo of your child so that we can make sure their image is not published or displayed.

Medical Declaration

Name of GP:*

GP Contact Number:*

Known conditions, allergies or medications:*

Please type N/A if necessary

Any dietary requirements:*

Please type N/A if necessary

Special needs or requirements:*

Please type N/A if necessary

I will inform the leaders of any important changes to my child's health, medication or needs and also of any changes to out address or to any of the contact details given above. 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 trained first aider, if available, or medical treatment to be administered by a suitably qualified medical practitioner. If I cannot be contacted and my child should require emergency hospital treatment, I authorise the leadership team to take my child to a suitable hospital. I understand that every effort will be made to contact me as soon as possible.*

Yes

Parental Consent

I give permission for my child to attend and to participate in Autumn Soul Weekend 2024.

If my child is unwell, in any way, I will not send them to Autumn Soul

Signature*

Date*

Date

GDPR Statement

The data collected on this form is held for the sole purpose of the named church. Written consent will be kept securely on file by the named church for a minimum of 7 years, as per the regulations stated in the General Data Protection Regulations for the Methodist Church in Ireland. If and when the form is no longer required it will be destroyed safely and securely. All members have the 'right to be forgotten' and can request that the named church clarify what details have been stored about them. However, due to any potential child protection, health and safety or security issues, information may need to be retained, if deemed necessary. If you wish to understand more about how the named church collects and processes data to be compliant with GDPR, please request the privacy policy.

Autumn Soul Parental Consent Form