Youth Consent Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Youth Consent Form

For the collection of personal parent/guardian information regarding email and text consent, and/or the child check-in system and Friday Youth consent. This data is solely for the use of New Life Christian Church Emsworth and will be stored in our secure database.

Child First Name *

Child Surname *

Child Gender *

Male

Female

Child Date Of Birth *

YYYY

Child School Year *

Child's Phone Number

Any medical conditions, including dietary needs or allergies? *

Please enter N/A if this does not apply

Any medication the young person carries? (Eg asthma pumps/diabetic medication)

Any instructions to follow in an emergency?

Yes

Clear selection

I consent to my child receiving emergency medical treatment (if required) *

Yes

Any social, emotional, behavioural or mental health needs? *

Yes

Please provide details and strategies for managing this

I consent to my child taking part in New Life Youth activities, including Friday night meetings, social events and life groups *

Yes

I consent to the youth team contacting my child about New Life Youth via the weekly text system. I understand I can withdraw this consent at any time. *

Yes

I consent to my child using the skate ramp. (By ticking this box, you also agree and sign the waiver found at newlifechurch.me/skaterampwaiver) *

Yes

Consent for when leaving the site *

I consent to my child leaving the site independently

I DO NOT consent to my child leaving the site independently

Do you have another child to add? *

Yes

Clear form

Never submit passwords through Google Forms.

This form was created inside of New Life Christian Church. Report Abuse

Forms