Croydon Youth Forum Consent Form

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The Croydon Youth Forum exists to provide a place where the voice of Christian young people in Anglican churches can be heard by senior leaders in Southwark Diocese.

Child's full name *

Child's Date of Birth *

YYYY

Church attended (eg. Christ Church, Purley) *

Child's Home address *

School year *

Parent/Guardian's name *

Parent/Guardian's phone number *

Parent/Guardian's email address *

Alternative emergency contact information (name, phone, email)

Family doctor's surgery (we will use this for residential purposes in the future) *

Does your child have any food allergies (please specify) *

Does your child have any medical conditions (please specify) *

Is your child on any medication (please specify) *

Does your child have any special needs *

Is there anything else we should know about your child

We request that a youth leader representing each church be present when we run group gatherings. But there are times when this may not happen. In this situation, please tick your preferences below (you can tick both options if you wish)

I would like my child to attend with a youth leader/adult

My child has permission to travel to and from the group without and adult

We will use a media platform to allow the young people to respond to topics of discussion and to connect with each other. The Whatsapp minimum age has increased to 16+ which makes it no longer a viable option. We intend to use Instagram with a privately accessed account by the Diocese, the young people and their youth leaders only. Please confirm if you are happy for your child to be connected on Instagram *

Yes

Child's Instagram account name

We would like to send a reminder of upcoming events to your child's phone. Anytime we do this, you will also receive the same message at the same time. We will not use their number for any other purposes. If they ask a question that needs a response, another adult with a DBS will be copied in to the message to fulfil safeguarding requirements. If you are happy with this, please provide your child's mobile phone number. *

Child's Email Address

In addition, due to Covid-19, we will be using Zoom for video conversations. Zoom has a 16+ age restriction, which means we will need your permission each time they attend a call if they are under 16. Details for Zoom will be sent separately. Please confirm that you are happy for your child to be connected on Zoom

Yes

Clear selection

Please specify if there are any platforms you are not happy for your child to connect with us through *

We include images of children in our publicity with their consent and the consent of their parents or guardians. We have a duty of care to reduce safeguarding risks by ensuring that children remain unnamed in publications. Images and video will be stored on the Diocesan server with access by the IT and Mission teams only. Please confirm your acceptance of our publicity below

Diocesan newspaper / Diocesan/CYP social media / CYP newsletter / Diocesan website / Other Diocesan / CYP publications

Media to be used for Diocesan meetings, such as synod: both diocesan & deanery, or used to inform at parish level (for example, videos made by and featuring the young people, related to specific discussion topics)

Please confirm the following statements as the parent listed above and the person completing this form

I give permission for my child to be part of the youth forum

In an emergency and/or if I am not contactable, I am willing for my child to receive medical or dental treatment including an anaesthetic.

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