Parental Consent Form – Lumen Christi Parish
This form is to be completed by a parent or authorised carer of a child under 16 attending a child-related or youth parish event without their parent present.Please complete one form per child.
Email
example@example.com
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Section 1 – Activity / Event Details
Date of Activity
*
-
Day
-
Month
Year
Date
Children's Liturgy Leader
*
Bronwyn Seaborn
Jodie Hillhouse
Kerrie Guillaume
Margaret Biggs
Megan Biggs
Samuel Franklin
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Section 2 – Child Details
Child’s Full Name
*
Address
*
Date of Birth
-
Day
-
Month
Year
Date
Age
Parent / Carer Name
*
Parent / Carer Phone
Parent / Carer Email
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Section 3 – Medical / Accessibility / Allergy Information
“Does your child have any allergies, medical conditions, disabilities, or dietary needs?
*
Yes
No
If Yes, show “Please list details
Emergencys
The parish will contact you immediately if an incident occurs.In urgent cases, Emergency Services will be called (costs may apply).
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Section 4 – Emergency Contact
Name
*
Relationship to child
*
Phone Number
*
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Section 5 – Photo / Media Permission
*
I consent to my child being photographed / filmed for parish purposes
I do not consent
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Section 6 – Parental Consent and Acknowledgements
*
I consent for my child to participate in the activity described above.
I agree parish personnel may provide basic first aid and request emergency medical treatment, including ambulance transport if required.
I confirm I am the parent / authorised carer and legally responsible for my child’s welfare.
Parent / Carer Digital Signature
Name
First Name
Last Name
Date
*
-
Day
-
Month
Year
Date
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Section 7 – Arrival & Pick-Up Authorisation
Details of Arrival & Pick up
*
My child will arrive and be collected by me
I authorise the following adult(s) to collect my child
My child has permission to depart unaccompanied (age-appropriate only)
Parent / Carer Signature (if different from above)
Other adult(s) to collect my child
I authorise the following adult(s) to collect my child
Date
*
-
Day
-
Month
Year
Date
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Submit
Should be Empty: