St. Peter's Youth Group General Consent Form
for parents with children wishing to attend St. Peter's youth events
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I agree to my child, named: *
Date of Birth *
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...participating in the youth group. I understand that, while involved, they will be under the control and care of the group leader and other adults approved by the church leadership and that, while the staff in charge of the group will take all 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. I acknowledge the need for them to behave responsibly and will ensure that they are aware of the expectation to behave responsibly.
TRANSPORT ARRANGEMENTS: (for which parents/carers hold responsibility). Please detail how your child will travel to and from youth group or the pick-up point.
MEDICAL INFORMATION: Does your child have any condition(s) requiring medical treatment including medication, e.g. inhalers, anti-epileptics or insulin? *
if yes to the above, please give details, and what treatments may be required during youth group meetings
Please outline any special dietary requirements of your child (including allergies e.g. nuts) and the type of pain/flu relief medication (or epi-pen) your child may be given if necessary.
Please outline any FEARS OR PHOBIAS your child has.(This information will assist the adult helpers to assist your child should any difficulties arise)
Is your child allergic to any medication e.g. penicillin? *
When did your child last have a tetanus injection?
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Is there any other relevant information/specific requirement(s) that need to be known by the organiser e.g. travel sickness/mobility? *
CONTACT NAME *
CONTACT PHONE NUMBERS *
CONTACT ADDRESS *
ALTERNATE EMERGENCY CONTACT NAME
ALTERNATE EMERGENCY CONTACT PHONE NUMBERS
ALTERNATE EMERGENCY CONTACT ADDRESS
FAMILY DOCTOR NAME
FAMILY DOCTOR PHONE
FAMILY DOCTOR ADDRESS
DECLARATION: I will inform the event leader as soon as possible of any changes in my child’s medical condition or other relevant information. In the event of an illness or accident every effort will be made by the event leader or their assistants to contact me.  If for whatever reason this is not possible I agree to my child receiving medication as instructed and any emergency dental, medical or surgical treatment, including anaesthetic or blood transfusion, as considered necessary by the medical authorities present.
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Other remarks
SIGNATORY FULL NAME *
SIGNATORY RELATIONSHIP TO CHILD *
SIGNATURE DATE *
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