Messy Church | Abbots Cross Congregational

Christ Church Congregational Abbots Cross

Trailblazers/Messy Church Consent Form

CHRIST CHURCH CONGREGATIONAL is fully committed to safe-guarding the wellbeing of all children who attend the Trailblazers Bible Club. To enable us to do this there is some information we need to know about your child. We would be grateful if you would complete this form and hit "submit" at the end.

I give my permission for my child to attend Trailblazers Bible Club and to participate in all their activities.

Child's name

Date of Birth

Day

Month

Year

Address

Post Code

Name of GP

Phone No. of GP

In the box below detail any other information we need to know to care for your child, including any known conditions, allergies and medication being taken:

Details

Parent/Guardian's Name

Please give phone numbers where you can be contacted

Phone Number 1

Phone Number 2

Please give additional emergency contact details below

Name

Emergency Contact Number

In the event of illness or accident, having parental responsibility for the above child, I give my permission for first aid to be administered where considered necessary by a trained First Aider or medical treatment to be administered by a suitable medical practitioner. I understand that every effort will be made to contact me as soon as possible but if I cannot be contacted and my child should require emergency hospital treatment, I authorise an adult leader to sign on my behalf any written form of consent required by the hospital. If there are any changes to any of the above details I will notify the Trailblazers leader.

Tick the box if you DO NOT wish your child to be included in photos or videos.

DATA PROTECTION: Christ Church Congregational need your permission to hold your personal details. We hold your personal information so we can keep you informed about Trailblazers and other Church events that may be of interest to you. We will also use your personal information to contact you in the event of an emergency. We undertake not to share your information with any third parties and will ensure that it is held securely. You can request your information be amended or removed at any time. If you are happy with this you do not need to do anything.

If you would like your personal information removed then tick the box below when submitting this form.

Please REMOVE my personal information from your database. (see name and address above)

Signature (Parent/Guardian)

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Date

Day

Month

Year