Dwell Youth Conference 2025 Consent Form

St Patrick’s Church presents Dwell 2025 Youth Conference Consent Form

Parental Consent form
Young person’s information
Name*

TileFirst NameSurname
Age*
Date of Birth*

MonthDayYear
Gender*
Email
example@example.com
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityCounty

Postal Code
Parent/Guardian or Emergency Contact Details
Contact Person Name*

TitleFirst NameSurname
Primary Phone Number*

Area CodePhone Number
Young Person’s Medical Information
GP Practice or Doctor’ name*

GP Practice Doctor’s name
Address*

Street Address

Street Address Line 2

CityCounty

Postal CodeCountry
Dietary Information
Please note that cooked hot food (main ingredients are mostly rice & meat), cold food and drinks will be served in the conference. Therefore it's important to share any known allergy or intolerance (including undiagnosed) your child has or have. Alternatively, all attendees are permitted to bring their own packed lunch if they desire not to eat at the conference food hall.
Do you have any known allergies? If yes, then please specify below.*
Are you currently taking medications? If yes, then please list the medications and the reasons why are you taking them.*
What is your current medical condition? Do you have any communicable disease, cardiovascular problems, diabetes, asthma etc.?*

Dwell Conference Media Use Consent
In the conference, we will be taking images of all attendees and activities performed in the event. For for this reason we are seeking for you and your child or children's consent to take photographs and videos of them. This will be used to evidence our event and for promotional purposes that relates to youth ministry and evangelism. It may be used by our parish St Patrick RC church for any religious promotional intended purposes.

Please be assured we will store these images safely and secure.
YesNo
Acknowledgment, Authorization and Waiver
I authorise for a trained first Aider in the event to carry out emergency first aid treatment or necessary procedure to my child.I understand my child may or will eat or drink in the event.I would inform my child’s parish youth group leader or the conference staff of any known infectious diseases that my child may have contracted prior to the event date.I acknowledge that all information I provided in this form is true and accurate.I am happy for my child to participate in the activities of the Dwell Youth conference.
Patient/Parent/Guardian Signature

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Date Signed

MonthDayYear
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St Patrick’s Church presents Dwell 2025 Youth Conference Consent Form