Youth event - Date

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Youth event - Date - Venue

Parental permission form

Email *

Please complete each question on this form to enable your young person to attend the above event, to be held in 1st Somewhere Presbyterian Church from 7.00 - 8:30pm on Sunday 37th June 2021.

Name of young person *

Has your child or anyone in your household shown any symptoms of Covid 19 within 10 days of this event? *

Yes

Name of parent / guardian *

Mobile number of parent / guardian *

I confirm that these details above are true to the best of my knowledge and agree to contact the leaders should there be any change or if my child or anyone in the household develops symptoms of Covid 19 or receives a positive test. I agree to my child attending this event and understand that they should remain 2 metres distant from others not in their household and follow the leaders' directions for their safety. *

I agree

Required

A copy of your responses will be emailed to the address you provided.

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