DEC Parental Consent Form

DEC Parental Consent Form

Anything that is written on this form will be held in confidence. We need to know this information to meet your child’s requirements and to ensure that they are in as safe an environment as possible. By completing this form, you are giving consent for your child to take part in activities led by Dun Laoghaire Evangelical Church.
Young Person's Details
First Child's Name*
First Child's Date of Birth*

DayMonthYear
Date
First Child's Mobile*
If you provide this number you are permitting DEC to contact your child by phone or text/WhatsAppFormat: (000) 000-0000.
Which DEC programme(s) does First Child attend?*
Second Child (if applicable)
Second Child's Name
Second Child's Date of Birth

DayMonthYear
Date
Second Child's Mobile
Please enter a valid phone number.Format: (000) 000-0000.
Which DEC programme(s) does Second Child attend?
Child's Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Person with Parental Responsibility
Name*

First NameLast Name
Address (if different from child)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Mobile*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Medical, Dietary, and Emergency Contact Details
Please list all food allergies or dietary requirements (N/A if none apply)*
Please list any medical conditions we should be aware of (N/A if none to list)*
Is there any medication that may need to be administered, and is the child able to do that themselves?
If DEC are unable to get in touch with me I nominate the person below to be my second point of contact:
Second contact's name*
Second contact's phone number*
Please enter a valid phone number.Format: (000) 000-0000.
Second contact's relationship to child*
eg. Parent/Grandparent/Aunt/Uncle
Photographic Images and Consent Statements

During the course of our regular activities we may take photographs/videos to be used both on the church website and in future event publicity. In order to publish an image of your child we need parental permission. All such photographs/videos will be handled in accordance with our Child Protection Guidelines and we will NOT publish any names or personal information.If you do not give permission for your child’s photo to be published, please make sure that your child is aware of this.
YesNo
By signing below, you give permission to the following:

I agree to my child participating in all DEC activities organised by the DEC Youth Ministry Team. I agree to inform leaders of any important changes to my child's health, medication, or needs. I give permission for first aid and/or medical treatment by a suitably qualified medical practitioner in the event of illness or accident. I authorise an adult leader to sign hospital consent forms if emergency hospital treatment is needed and I cannot be contacted. I confirm that the details provided are correct and consent is given as stated above.
Parent/guardian signature*

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DEC Parental Consent Form

Young Person's Details

Second Child (if applicable)

Person with Parental Responsibility

Medical, Dietary, and Emergency Contact Details

If DEC are unable to get in touch with me I nominate the person below to be my second point of contact:

Photographic Images and Consent Statements

By signing below, you give permission to the following: