Impact Parental Consent Form

 

Please complete the form below

Name of Young Person *
Name of Young Person
Young Person's Address
Young Person's Address
Gender *
Name of Parent/Carer
Name of Parent/Carer
Please state if your child has any allergies, requires any special diets, receives regular medication or if there is any other important information about your child we need to know. We may contact you for more information about this.
Emergency Contact Details
In the event of an emergency and we are unable to make contact with the parent/carer, please advise us of someone else who may act as an additional emergency contact.
Emergency Contact Name
Emergency Contact Name
Emergency Contact Address
Emergency Contact Address
Activities Consent
Do you give permission for your child to take part in the activities available through IMPACT, which includes transportation with leaders authorised by Cartsbridge Evangelical Church to use own cars / minibus / public transport, outings, visits, outdoor and indoor activities *
Photography and Publicity Consent
Occasionally photographs/videos of the children/young people are taken during IMPACT activities to be used on social media and for raising awareness of Impact.
Do you give permission for your child to be photographed by an authorised member of the IMPACT leadership team during the course of IMPACT activities
Do you give permission for images of your child to be used in IMPACT or church publicity including, but not limited to; the church website, church newsletters, newspaper articles, etc. *
Declaration
I have understood and give my consent to the above, until the consent is withdrawn in writing. Any information contained in this form will be treated with respect and confidentiality. Information will be stored securely and used sensitively.
Please type your name here. This constitutes an e-signature