Parental Consent and Data Privecy Form

Parental Consent and Data Privecy Form
SECTION 1 - Basic Information

Families wanting to sign up more than one child can do so on this form (up to 3) to save the trouble of filling out three separate forms. Young people 18 years of age and over can sign this form themselves.
Young Person # 1 *

First Name Last Name
Date Of Birth *
Young Person # 2

First Name Last Name
Date Of Birth *
Young Person # 3

First Name Last Name
Date Of Birth *

Home Address *

Street Address
Street Address Line 2
City	State / Province
Postal Code	Country

Phone Number *

Area Code Phone Number
Young Persons Email # 1
example@example.com
Young Persons Email # 2
example@example.com
Young Persons Email # 3
example@example.com
Parents / Guardian Full Name *

First Name Last Name
Parents / Guardian Email *
We ask you the parent of your child to supply us your email so we can send you a copy of the completed form and to verify that you the parent / guardian have completed this form alongside your Child.
Parent / Guardian Passport number / Drivers Licence (Last 4 digits) *
For Authenticity Purposes
Will you collect your child at the end of club (21:00) or Is your child / children to walk home (the volunteer leaders take no responsibility for transportation to and from GEN|youth)?

Pick up Walk Home
SECTION 2 - Emergency Contact Details
Parent / Guardian Person to be contacted *

First Name Last Name
Relationship to young person *
Home Phone Number *

Area Code Phone Number
Mobile Phone Number *

Area Code Phone Number
Work Phone Number

Area Code Phone Number

Parent / Guardian Address (if different to child)

Street Address
Street Address Line 2
City	State / Province
Postal Code	Country

Alt. Emergency Contact Name

First Name Last Name
Alt Home Phone Number

Area Code Phone Number
Alt Mobile Phone Number

Area Code Phone Number
SECTION 3 - Medical Information

Please make sure the correct medical information is given in the right field that corresponds to the childs number as in section 1. We are collecting this information (your name, address and contact details, your child/ren’s allergies and medication) to enable the church to run youth and residential activities safely and to ensure that we can contact you (or other nominated adult) in case of emergency. If you are unable to supply the information requested then we will be unable to accept your child’s participation in youth activities. You can also request the church to remove the data it holds about you and your child/ren.
Name of Family DR *

Prefix First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal Code	Country

Phone Number *

Area Code Phone Number
Name Young Person # 1 *

First Name Last Name
Does your child suffer from any medical condition or have any allergies (including food/drink) that we should be aware of? *
Does your child have any particular needs that it would be useful for us to know about? *
Name Young Person # 2

First Name Last Name
Does your child suffer from any medical condition or have any allergies (including food/drink) that we should be aware of?
Does your child have any particular needs that it would be useful for us to know about?
Name Young Person # 3

First Name Last Name
Does your child suffer from any medical condition or have any allergies (including food/drink) that we should be aware of?
Does your child have any particular needs that it would be useful for us to know about?
Medical Declaration
I agree to my son / daughter receiving medical or dental treatment, including anesthetic, as considered necessary by the medical authorities present.I understand that personal accident insurance cover for my child is my responsibility. *

Yes No
SECTION 4 - Photography, Video & Social Media
PARENT / GUARDIAN I understand that group photographs and videos will be taken and I give permission for my child to be included in these. Photographs / Videos may be used within local reporting and closed social media pages and similar.

Yes No
YOUNG PERSON # 1 I understand that group photographs and videos will be taken and I give permission and consent to be included in these. Photographs / Videos may be used within local reporting and closed social media pages and similar.

Yes No
YOUNG PERSON # 2 I understand that group photographs and videos will be taken and I give permission and consent to be included in these. Photographs / Videos may be used within local reporting and closed social media pages and similar.

Yes No
YOUNG PERSON # 3 I understand that group photographs and videos will be taken and I give permission and consent to be included in these. Photographs / Videos may be used within local reporting and closed social media pages and similar.

Yes No
SECTION 5 - Rules of GENERATE|youth

As developed and agreed by the young people and Leaders.
- Respect the leaders, the other young people and their property, yourselves and the building. Therefore, swearing, bullying, fighting or bringing drugs, alcohol or weapons of any kind to club is strictly forbidden.
- Participate in activities.
- Phones are to be used for emergency only. I agree to relinquish my phone to be stored safely until free time is given.
- If I mess up I clear up.
- HAVE FUN!
PARENT / GUARDIAN I agree to my son / daughter taking part in the GEN|youth Club 2018 and agree to their participation in the programmed activities. I acknowledge the need for responsible behaviour on their part and understand that a verbal warning will be issued twice before my child is asked to leave and I will be contacted to collect my child. *

Yes No
YOUNG PERSON # 1 I agree to participate in the programmed activities with responsible behaviour and understand that if after two verbal warning I am asked to leave I will do so immediately and if required my parent / guardian will be contacted to collect me. *

Yes No
YOUNG PERSON # 2 I agree to participate in the programmed activities with responsible behaviour and understand that if after two verbal warning I am asked to leave I will do so immediately and if required my parent / guardian will be contacted to collect me.

Yes No
YOUNG PERSON # 3 I agree to participate in the programmed activities with responsible behaviour and understand that if after two verbal warning I am asked to leave I will do so immediately and if required my parent / guardian will be contacted to collect me.

Yes No
SECTION 6 - OVER ALL DATE PRIVECY
Your privacy is important to us, and we want to communicate with church members and friends in a way which has their consent, and which is in line with UK law on data protection. As a result of a change in UK law, we now need your consent to how we contact you. Please fill in the contact details you want us to use to communicate with you

Post Email Phone Text Message Social Media
To correspond with me about activities my child/ren are involved in; To keep me informed about other youth activities which you may be interested in To hold emergency contact details and your child/ren’s allergies and medication information
You can grant consent to all the purposes; one of the purposes or none of the purposes. Where you do not grant consent we will not be able to use your personal data; (so for example we may not be able to let you know about forthcoming activities or allow your child to take part in youth activities); except in certain limited situations, such as where required to do so by law or to protect members of the public from serious harm.
You can withdraw or change your consent at any time by contacting the Church Office or on info@christiancentre.info. Please note that all processing of your personal data will cease once you have withdrawn consent, other than where this is required by law, but this will not affect any personal data that has already been processed prior to this point.
Should be Empty:

SAVE 25%

on monthly & annual plans

Create your own JotForm

Parental Consent and Data Privecy Form

SECTION 1 - Basic Information

SECTION 2 - Emergency Contact Details

SECTION 3 - Medical Information

Medical Declaration

SECTION 4 - Photography, Video & Social Media

SECTION 5 - Rules of GENERATE|youth

SECTION 6 - OVER ALL DATE PRIVECY