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St Andrew's Church > Children > Parental Consent Form and Medical Information

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Monday 13 September
6:00pm		Football @ St Clement Danes Astroturf

Friday 17 September
2:20pm		Backstage @ Chorleywood Primary School

Friday 17 September
4:15pm		Keys @ Lounge

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Children's Ministry

Parental Consent Form & Medical Information

Child's Details

Full Name:

Date of Birth:

Parents full name(s):

Address:

Town:

County:

Postcode:

Country:

Email Address:

School:

School Year:

MSC Group:

Telephone:

Mobile:

Emergency contact number if different from above:


Alternatively emergency contact person in case we are unable to contact you in the event of an emergency (please state their relationship to your child):

    Name & Relationship:

    Phone:

Family Doctor's Name:

Family Doctor's Phone:

Surgery Address:

Medical Information

Does your child suffer from any conditions needing regular medical treatment?
If yes please give appropriate details below:

Does your child have any allergies (including to medication)?

If yes please give appropriate details below:

Does your child have any special needs affecting their participation in normal group activities?

If yes please give appropriate details below:

Details if necessary:

Come Onboard!

In partnership with the family, our vision is that every child would be a deeply discipled, natural missionary in their home, school and MSC.

We are so are so excited about all that God wants to do in and through children. For those of us who lead them it’s a massive privilege and we don't want you to miss out! We’d love you to consider joining one of our children’s teams either in your MSC or at the church centre.

If you’d like to find out more please indicate how you would like to be contacted below:

Phone Email Post

Parental Consent

Please tick the following that apply to your child:

I give permission for my child to attend the following activities recognising that they are under the responsibility of the Children’s Department staff and other approved adult volunteers: (details of different events available from www.st-andrews.org.uk/children )

Sunday Mornings at our MSC & The Church Centre

Midweek Groups at our MSC

Football (Children are supervised at all times, however, minor injuries do occasionally occur. Attendance in bad weather is at parental discretion)

Flava (Children are supervised at all times, however, minor injuries do occasionally occur. Attendance in bad weather is at parental discretion)

VIP Lounge *

Air*

Keys *

Socials and other events held at the Church Centre

* (Including offsite activities and guided socials which may involve travelling in a car with a responsible adult. Children will be directly supervised at all times.)

I give permission for photographs/video to be taken of my son/daughter whilst participating in group activities and for images/footage to be used in and around St Andrew’s as appropriate (including website).

I give permission for my son/daughter to receive any medical treatment deemed necessary by a qualified medical practitioner—including general anaesthetics and emergency dentistry. I understand that every effort will be made to contact me but that priority will be given to the safety and well being of the child concerned.

I give permission for my son/daughter to be given a plaster for minor abrasions upon their request.

Name of person completing this form:

By clicking send I confirm that all the information given is correct and that I am a parent / guardian of the child concerned.

Andy Hayball, 17/08/2009