Event details Name of event/group:
Dates & Times: Online platform being used:
Details of young person
Full name: ___________________________________________________________________________
Address: ____________________________________________________________________________
____________________________________________ Postcode: _________________________
Email Address: _________________________________ Mobile Number: ____________________
Date of birth: __________________________________ Gender: _______________________
Contact details of parent/carer/person legally responsible for young person (essential for those under 13)
Name: _______________________________________ Relationship: _______________________
Address: ___________________________________________________________________________
Home phone: __________________________________ Other phone: ______________________
Email address: _______________________________________________________________________
Details of alternative emergency contact
Name: ____________________________________________________________________________
Home phone: __________________________________ Other phone: _____________________
General consent Please read these statements and make sure you understand them. It is important that a parent, guardian or someone with legal responsibility for the young person sign these statements.
I give consent for ________________________ to attend and take part in the online engagement above. I know that it is important for the young person to behave responsibly and to agree to the code of conduct.
I understand that during the on-line periods of event the young person will be under the care and supervision of responsible youth workers appointed by the [name of church].. While these workers will take all reasonable care of the participants, they cannot necessarily be held responsible for any loss, damage or injury suffered during, or as a result of, the engagement.
Signed: _____________________________________ Date: ___________________________
Please return (via the parent/carer’s email account) to [email address] by [date].
........................................................................................................................................................
Event details Name of event/group:
Dates & Times: Online platform being used:
Details of child / children (please complete information for each child)
Full name: ___________________________________________________________________________
Address: ____________________________________________________________________________
____________________________________________ Postcode: _________________________
Date of birth: __________________________________ Gender: _______________________
Contact details of parent/carer/person legally responsible for child/children (essential for those under 13)
Name: _______________________________________ Relationship: _______________________
Address: ___________________________________________________________________________
Home phone: __________________________________ Other phone: ______________________
Email address: _______________________________________________________________________
Details of alternative emergency contact
Name: ____________________________________________________________________________
Home phone: __________________________________ Other phone: _____________________
General consent Please read these statements and make sure you understand them. It is important that a parent, guardian or someone with legal responsibility for the child/children sign these statements.
I give consent for ________________________ to attend and take part in the online engagement above. I know that it is important for a parent or guardian to be present and to behave responsibly, and to agree to the code of conduct.
I understand that during the on-line periods of events,, alongside the care and supervision of a parent or guardian, my child/children will be under the care and supervision of responsible children’s workers appointed by the [name of church]. While these workers will take all reasonable care of the participants, they cannot necessarily be held responsible for any loss, damage or injury suffered during, or as a result of, the engagement.
Signed: _____________________________________ Date: ___________________________
Please return (via the parent/carer’s email account) to [email address] by [date].
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