Youth Parental Consent

Parental Consent Form

By completing this form, you are giving consent for your child to take part in Youth activities at St Werburgh's Church, Chorlton.

Young Person's Details

Name *

Address

Date of Birth *

Ethnicity *

School *

Please list any relevant food allergies or dietary requirements of the young person.

Please list any medical conditions we which we should be aware of the young person

Registered for Free School Meals *

Young Carer *

Young Carer A young carer helps to look after a relative with a disability, illness, mental health condition, or drug or alcohol problem.

Parent or Carer

Parent Name *

Address

If different from child

Parent Mobile *

Parent Email

Second Emergency Contact

Name *

in case of emergency, please provide a second contact.

Contacts Mobile *

Photographic Images

During the course of our regular activities we may take photographs to be used both on the church website and in future event publicity. In order to publish an image of your child we need parental permission. All such photographs will be handled in accordance with our Child Protection Guidelines and we will NOT publish any names or personal information.

I grant permission for the church to publish images of my child in promotional publications, the church website and online social media...

My child in an individual photo *

Yes

My child in an group photo *

Yes

After the group my child will be collected / travel home alone.

Please note any change to this must be given in writing.

Collected

Travel home alone

Any thing else we need to know?

Signed *

Parent/guardian signature required

I accept your Data Protection Policy