General Information and Consent Form

General Information and Consent Form

In order to ensure your child's safety we would be grateful if you would complete and return this form. Please let us know if any of these details change. A copy will be retained confidentially by the group leader.
Congregation (if applicable)
Name of child or young person

First NameLast Name
Date of birth of child or young person

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
What dates are child/young person attending
Year Group as of August 2026 (eg Primary 2)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact details

Please read the following information carefully and indicate your consent by checking the box below. By checking the box, you agree that your personal data may be collected and processed for the following purposes: marketing communications, customer support, and service improvement.
Name of parent or guardian responsible for child or young person

First NameLast Name
Email address of parent or guardian
example@example.com
Contact number of parent or guardian
Address of parent or guardian

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of additional person responsible for child or young person
Contact number of additional person responsible
Medical information

Please outline any medical and dietary requirements we need to be aware of
Name of GP
GP Telephone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of last Tetanus
Details of any regular medication, medical condition (e.g. asthma, epilepsy, diabetes, allergies, dietary needs) or disability which may affect normal activity
I give permission for my child as named above to participate in the normal activities of this group.

I understand that separate permission will be sought for certain activities and outings lasting longer than the normal meeting time of the group.

I understand that while involved in the activities of this group, they will be under the control and care of the group leader and/or other adults approved by the church leadership and that, while the staff in charge of the group will take reasonable care of the children, they cannot necessarily be held responsible for any loss, damage or injury suffered by my child during, or as a result of the activity. In an emergency and/or I cannot be contacted, I am willing for my child to receive necessary hospital or dental treatment including an anaesthetic.

If you have any queries, please contact the Church of Scotland Law Department (lawdept@churchofscotland.org.uk; 01312255722)
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
The purpose of the UK Data Protection Act 2018 is to ensure that any personal data an organisation holds about an individual is stored and used in an appropriate way. This congregation, through presbytery, is registered with the Information Commissioner's Office and strives to comply fully with data protection law. The Information Commissioner's website provides in-depth information regording the requirements of the Data Protection Act: https://www.ico.org.uk/

This congregation is committed to protecting privocy and sofeguarding personal data. We shall use the information you have provided us with for sofeguarding purposes and related motters and will only keep the data for as long as required for that purpose. The full Privacy Notice for our congregation is available on our website. Please ask for details from your Safeguarding Coordinator. Should you hove any questions concerning the use of the information you provide please contact the Safeguarding Coordinator.

General Information and Consent Form

Contact details

Medical information

Media Consent Form