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Stapleford Youth Club Consent Form
For school Years 5-11
This form is to be completed by a parent/guardian.
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* Indicates required question
Email
*
Your email
Which group/activity are you signing up for?
*
Friday Youth Club
Mentoring
Required
Young persons name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Address (inc. postcode)
*
Your answer
Any medical needs or anything else leaders should know:
*
Your answer
Who will be collecting the young person? You can name multiple people/give permission for young people to make their own way home. You MUST notify us if this changes.
*
Your answer
I give permission for pictures and/or videos to be taken and stored securely of the young person named above and shared on St Andrew’s social media, website, displays and hard copy publicity materials.
*
Yes
No
Parents name
*
Your answer
Are you happy for us to email you with information and updates about future groups and activities?
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Yes
No
Emergency contact number
*
Your answer
Would you like to join our parents WhatsApp group for updates on groups/trips?
*
Yes
No
Please enter young person's phone number if they would like to join our youth WhatsApp group for updates on groups/trips? (Year 7+ only)
Your answer
Guidelines
Young people attending the Stapleford Youth Group should:
- Only attend once a signed consent form has been returned
- Dress appropriately for all sessions
- Not use inappropriate language
- Listen and respect everyone else
Anybody breaking these rules will be asked to leave and the parent/guardian will be contacted.
I agree to these guidelines and have explained them to my young person:
*
Yes
No
Parent/Guardian Declaration
I give consent for my child to participate in St Andrew’s Stapleford Youth Groups at the Johnson Hall. St Andrew’s and its staff and volunteers will take all due care & responsibility for my child’s safety and welfare, but I recognise that St Andrew’s Stapleford is only liable for injury caused by their negligence. St Andrew’s has insurance for such an eventuality but does not otherwise provide personal insurance for participants.
I agree to this declaration
*
Yes
No
Required
Social Media
St Andrew’s has a number of social media accounts including, but not limited to, Facebook and Instagram.
I give consent for St Andrew’s to communicate with my child through public social media posts where appropriate.
*
Yes
No
Thank you for completing this form. Don't forget to click submit!
We look forward to meeting you soon.
Friday's at the Johnson Hall:
Youth (Yrs 5+) 3:30-5:00 pm
Explore (Yrs 5+) 5:00-6:00 pm
A copy of your responses will be emailed to the address you provided.
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