Parental Consent Form

At KFSW we want to make sure your child/young person is well looked after while they are taking part in our kids work.  Please help by providing us with a little bit of information about your child/young person (and do inform the leaders in charge of any changes to this information throughout the year). Please complete a form for each child / young person.

By completing this form you are giving consent for your child to take part and for KFSW to hold your child's data for as long as they attend the group.  

Which age group does your child/young person belong to?	Please selectLittle Builders (1-3yrs)Superkids (4-9yrs)Elevate / Youth Connect (10-15yrs)
Name of child/young person:

Address:

Mobile/Telephone:

Child/young person's date of birth:

Age:
Sex:

Name of Doctor

Doctor's address:

Does your child/young person have any allergies?

Does your child/young person require any regular medication?

Parent/Carer name:

Parent/Carer address (if different from above):

Parent/Carer telephone (if different from above):

Relationship to child/young person:

Do you have parental responsibility (tick as appropriate):

Yes  No

 

Please provide an alternative contact in case of an emergency - by supplying this you are confirming that consent has been given for us to hold this information:

Contact Name:

Relationship to child/young person:

Telephone number:

By submitting this form you are agreeing to the following statements:

I understand every effort will be made to contact me as soon as possible should my child/young person become ill or have an accident.

I acknowledge that while leaders are in charge they will take all reasonable care of the children/young people and unless they are negligent cannot be held responsible for any loss, damage or injury suffered by any child/young person arising during organised events.

I ensure that my child/young person understands as far as is reasonably possible that it is important for their safety and the safety of the group as a whole that any instructions given by the team are followed.

I understand from time to time photographs/videos (by camera or phone) will be taken by leaders at KFSW events.  All photographs and video remain the property of KFSW and no reward will be given for those featured.  Please note that we do not allow unauthorised photography or video.  I understand that no child/young person will be identified by name.

I give permission for my child / young person to be in photographs and / or videos and for them to be used for publicity purposes :   YESYES - but not publicNO

Thank you for filling in this form, if you have any questions or concerns please do get in touch with us.