Second Broughshane Presbyterian Church; youth and children consent form (2022-23).

Second Broughshane Presbyterian Church

Youth and Children's Organisations Consent Form 2025-2026
Child's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

TownCounty

Postal code
Child's Date of Birth*

DayMonthYear
Date
Child's current age*
Child's school year this September 2025*
Which Organisations will this child attend?

Please check the box for each organisation your child will attend.
Boys' Brigade

Boys' Brigade
Girls' Brigade

Girls' Brigade
Kids' Church

Kids' Church (Primary age)
Junior CE

Junior CE (Primary age)
Senior Sunday School

Senior Sunday School (Post-primary age)
SEED Youth Fellowship

SEED Youth Fellowship (Post-primary age)
P.L.A.Y

P.L.A.Y (Parents and toddlers)
Creche

Creche
Important Information

Please provide all contact and emergency information.
Parent Name*

First NameLast Name
Parent Email*
example@example.com
Parent Tel Number*
Please provide details of a second adult to contact in the event of an emergency. (Parent will be the first emergency contact).
Emergency contact*

First NameLast Name
Emergency contact number*
Does your child have any medical conditions or allergies? Please include details of any medication that is relevant to us.
Medical Consent
I confirm that, in the event of illness or accident, having parental responsibility and care of the above-named child, I give my permission for medical treatment to be administered where considered necessary by a nominated first aider, or by suitable qualified medical practitioners. If I cannot be contacted and my child should require emergency hospital treatment, I authorise an adult leader to sign on my behalf any written form of consent required by the hospital. However, I understand that every effort will be made to contact me as soon as possible. I will update the church/organisation if there are changes to the child's medical needs.
In relation to the medical details above, I give my consent.*

check the box
Is your child permitted to walk home without an adult?*

YesNo
Publicity and Photograph Permission

Please tick the boxes below to let us know you ARE happy for photographs to be used
Photographs/videos may be taken during some organisations. Please indicate your permission for the usage of photos/videos;
a) on our digital screens in church
b) on our facebook page and website
c) in print newspapers and church magazine

Please tick the boxes below to indicate that you are happy for photographs to be used;
digital screens in churchfacebook page and websitechurch magazine and newspapers
Signature

Please provide a signature of parent/guardian
This form must be signed by a parent/guardian. Please sign carefully in the box below.
Parent/Guardian Signature*

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GDPR

Information submitted on Parental Consent Forms will be held securely and in confidence under General Data Protection Regulation 2018 guidelines. This form requests permissions for the taking and use of your child's photographs and requests personal information about your child and you as parent or guardian. The Organisation Leaders need to know this information in order to best meet and safeguard the specific needs of your child. Please note, the Church will not disclose any personal details of children unless this is specifically authorised in relation to special awards or events.
Should be Empty:

Second Broughshane Presbyterian Church

Which Organisations will this child attend?

Important Information

Publicity and Photograph Permission

Signature