Child Consent Form

Part A

Name of group: Christ Church Network Children's groups

Brief description of activities: Bible story, discussion, games, activities & refreshments

Part B

(To be completed by a Parent or Legal Guardian of under 18's)

Child's full name
Date of birth (dd/mm/yy)
Normal address
School attended
Does your child take any regular medication or have a medical condition (e.g. Asthma, epilepsy, diabetes, any allergies, dietary needs etc) or disability which may affect normal activity?
Does your child have any educational or behavioural needs that we should be aware of?
In an emergency or if I am not contactable, I am willing for my child to receive necessary hospital treatment including an anaesthetic.
My child can be given penicillin.

I give permission for my child to take part in the normal activities of the group. I understand that separate permission will be sought for certain activities away from the normal meeting place. I recognise that while involved he/she will be under the control and care of the group leaders approved by the church eldership and that while those in charge will take all reasonable care, they cannot necessarily be held responsible for any loss, damage or injury suffered by my child during, or as a result of the activity.
Tick here to give your consent:

Parent/Guardian name
Home tel
Mobile
Email

Part C

(To be completed by a Parent or Legal Guardian of under 18's)

I give permission for photographs/video of my child to be taken as part of the group activities and used for legitimate purposes relating to the group or the Christ Church Network, including publicity, displays, website and social media. Under 18's will not be identified by name on any photographs without expressed permission.
I give permission for my child to get to and from the group without parental supervision.

It is often useful if the group leaders can contact your child directly by mobile phone or email with messages relating to the group. If your child has a phone and/or email and you agree to this please give your child's phone number and/or email address below.

Child's Mobile
Child's Email