Peterhead Methodist Church Youth Work
ANNUAL PARENTS' CONSENT FORM
(For all age groups) PART 'A' (To be filled in by youth worker)
Church Group:______________________________________
Leader in charge: ____________________________________
PART 'B' (To be filled in by parent or guardian)
Full name of child :______________________________________________
Date of Birth :______________________________________________
PERMISSION I give my permission for him/her to attend and take part in the activities of the group. Group activities: Team games; class work, Christian teaching and one off excursions during normal youth group times.
MEDICAL DETAILS Details of any medical condition leaders should be aware of (including any medication your child may need to take whilst at the group)? _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________
Signed: ________________________________________________ (PARENT/GUARDIAN)
Address _________________________________________________ _________________________________________________
Telephone : ________________________ (day) ___________________________ (evening) Date : ___________________________
It is possible that members may appear in photographs or other media that will be used for publicity purposes (Church Magazine, Newsletter, local newspaper, church Website, etc). Care will be taken to ensure that addresses of individuals are not given.
If you would prefer your child not to be included in such media please indicate below. I DO/DO NOT (delete as appropriate) give permission for my child to appear in photography or other media used by the church.
Signed ___________________________________ (PARENT/GUARDIAN)
Date______________
Peterhead Methodist Church Youth Work
PARENTS' CONSENT FORM SPECIAL EVENT / ACTIVITY (OVERNIGHT STAY OR HAZARDOUS ACTIVITY)
(For all age groups)
Please return to Leader in charge more than seven days before the event.
PART 'A' (To be filled in by the youth worker)
Group:______________________________
Activity or Event: _____________________
Venue: ______________________________
Dates: ______________________________
Leader in charge______________________
PART 'B' (To be filled in by parent or guardian)
Full name of child: ______________________________________________
Date of Birth: ______________________________________________
PERMISSION I give my permission for him/her to attend and take part in the activities or event named in Part 'A'. I understand that in the event of any illness or accident, every effort will be made to contact me, but if this is not possible, I authorise any youth leader to sign on my behalf, any written form of consent required by medical authorities.
MEDICAL DETAILS
Name & Address of child's doctor _______________________________________________ _______________________________________________
Doctor's Telephone ______________________________________________
National Health Service Number (if known)________________________________
Details of any infectious disease with which your child has been in contact within the last three weeks: ____________________________________________________________ ____________________________________________________________
Details of medicine/diet/treatment which is being taken/followed: ____________________________________________________________ ____________________________________________________________
Details of known allergies/sensitivities (e.g. Penicillin): ____________________________________________________________
He/she has / has not * been immunised against tetanus within the last five years. (* Delete as appropriate)
Signed: ________________________________________________ (PARENT/GUARDIAN) Address _________________________________________________ _________________________________________________
Telephone: _________________________ (day) ___________________________ (evening)
Date: ___________________________