Parental Consent Form

At KFSW we want to make sure your child 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 (and do inform the leaders in charge of any changes to this information throughout the year). Please complete a form for each child.

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.  

Name of child:
Address:
Mobile/Telephone:
Child's date of birth:
Age:
Sex:    
Name of Doctor
Doctor's address:    
Does your child have any allergies?
Does your child require any regular medication?
Parent/Carer name:
Parent/Carer address (if different from above):
Parent/Carer telephone (if different from above):
Relationship to child:

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:
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 become ill or have an accident.
  • I acknowledge that while leaders are in charge they will take all reasonable care of the children and unless they are negligent cannot be held responsible for any loss, damage or injury suffered by any child arising during organised events.
  • I ensure that my child 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 will be identified by name.

 I give my permssion for my child to be in photographs and/or videos and for them to be used for publicity purposes (untick if preferred).
 I give my permission for my child to be in photographs but not for them to be shared publicly.
 I do not give permission for photographs or videos to be taken of my child.

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