1eighty parental consent form

St Botolph’s Church takes its safeguarding responsibilities seriously. All members of the Youth Ministry team have had an enhanced DBS check. A copy of our safeguarding policy is on our website and a printed version is available on request.

 

Data Protection:

Due to the Governments new data protection laws we need your express permission to keep your details… (without this we will be unable to contact you and will need to delete any details we currently hold). This includes young people 13 and over.

 

 

 


Member's Name:*
Age:*
Date of Birth:*
School attended:*
School year:*
Member's email address:
To be completed by 1eighty member only if 13 or over. I give permission for St Botolph’s church to hold my data so that I might be contacted in the future about relevant events and information about 1eighty.:
YES
No
I am happy to be contacted by: (please tick) [to be completed by member]:*
Email
Phone
Post
Whats App
Zoom
Instagram
Please tick box to sign this section:*
Signed
Parent to complete please - Address:*
Parent's email:*
Home phone number:
Emergency contact number:*
I am willing for my child to attend outings or day trips organised by 1eighty and understand that they will be under the supervision of the 1eighty leadership and other adults as appropriate :*
YES
NO
I give permission for my child to be photographed or filmed during an “1eighty” event and also permit these pictures to be used by St. Botolph’s Church.:*
YES
NO
I consent to my child being given any necessary first aid or medical treatment whilst attending “1eighty”.:*
YES
NO
Does your child suffer from any condition requiring regular medication/treatment?:*
YES
NO
Please give details if appropriate.:
Does your child suffer from any allergies?:*
YES
NO
Please give details if appropriate.:
Does your child have any special dietary requirements?:*
YES
NO
Please give details if appropriate.:
Name of parent or guardian.:*
I give permission for St Botolph’s church to hold my data, and that of my child/child I am responsible for (if 12 or under) so that we might be contacted in the future about relevant events and information about St Botolph’s, 1eighty.:*
Signed
I am happy to be contacted by::*
Email
Phone
SMS
Post
Whats App
Signature of parent or guardian:*
Signed
Date:*
Please enter the verification number on the right:*
one two one one one
* Required Fields