YMIC Consent Form - March 2023

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Welcome to Youth Ministry in Communion!

Before attending the youth event on Sunday 5th March 2023 it's important that we have some emergency contact information and consent to attend from parents/guardians. Please complete this form to sign up to the event and provide us with important information.

PLEASE COMPLETE THIS FORM FULLY AS REQUESTED.

THIS FORM MUST BE COMPLETED BY A PARENT OR LEGAL GUARDIAN!

Please provide parent/guardian email address in the box below - this is only so that we can send you a confirmation email of receipt of this form.

Email *

𝗗𝗘𝗧𝗔𝗜𝗟𝗦 𝗢𝗙 𝗬𝗢𝗨𝗡𝗚 𝗣𝗘𝗥𝗦𝗢𝗡

Young Person's SURNAME *

Young Person's FIRST Name *

Young Person's Date of Birth *

YYYY

Young Person's Address and Postcode *

Please include all details, this is needed for emergency situations.

Ethnicity

Asian or Asian British

Black, Black British, Carribbean or African

Mixed or Multiple Ethnic Group

White or White British

Other

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What Church Are They From? *

School They Attend

School Year *

Please let us know about any allergies/medical conditions that your child has and any other relevant information

For example, "My child has Asthma and needs to carry their inhaler. Allergic to nuts"

𝗖𝗢𝗡𝗦𝗘𝗡𝗧 𝗔𝗡𝗗 𝗘𝗠𝗘𝗥𝗚𝗘𝗡𝗖𝗬 𝗗𝗘𝗧𝗔𝗜𝗟𝗦

Emergency Contact 1 (Name) *

This should be the main parent/carer - the person completing this form.

Emergency Contact 1 (Phone Number) *

Emergency Contact 2 (Name) *

This should be someone you trust if you are uncontactable in an emergency.

Emergency Contact 2 (Phone Number) *

Parent Declaration

I give permission for the child named above to attend the youth event on Sunday 5 March 2023.

I understand that at such activities my child will be under the care of the group leader (Youth Worker), and/or other adults approved by the YMIC leadership. I also understand that whilst all staff and volunteers will take all reasonable care, they cannot be held responsible for any loss, damage or injury suffered during or as a result of activities.

I give permission for my child to leave the event without a parent/carer OR I will arrange with my group/parish's leader to collect my child/ward.

In an emergency and/or I am uncontactable, I am willing for my child to receive necessary medical treatment including anaesthetic.

I agree to the above 'Parent Declaration' *

Yes

Photo Consent *

Are you happy for your child to feature in pictures and videos which will be used for YMIC publicity.

Yes

Parent/Guardian Name (Adult Filling out this Form) *

Parent/Guardian Email Address: *

Would you like to join our mailing list? We promise not to spam you and only send info about our quarterly youth events. *

Yes

Thanks for taking time to complete this important form! We're really looking forward to your child joining us. Please get in touch if you have any questions.

Jacob Holme
Project Leader
Tel: 0203 375 6595
Email: jacob@standrewsfulham.com

Youth Ministry in Communion is a project operated by the PCC of St Andrew's Fulham Fields. Your details will be stored safely in both print and digital versions. You can find our privacy notice here: www.standrewsfulham.com/data-protection

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

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