ASC Tots Consent Form
Thanks for taking 5 minutes to fill out this form, please fill in one for each child you have.
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Email *
Name (Parent) *
Phone Number *
Email address *
Home address *
Name (child) *
Date of Birth *
*
Second Adult contact - Name and Number *
Any food allergies? *
Any medical conditions we need to be aware of? *
Doctor name and number? *
If I cannot be contacted and my child should require medical hospital treatment, I authorise an adult leader to sign, on my behalf, any written consent form required by the hospital. I understand however, that every effort will be made to contact me using the telephone numbers given above as soon as possible. *
In the event of illness or accident, having parental responsibility for the above child, I give permission for first aid to be administered when considered necessary by a trained first aider, if available, or medical treatment to be administered by a suitably qualified medical practitioner. *
CONSENT FOR PHOTOS AND RECORDED IMAGES

In accordance with our child protection policy, Safeguarding Trust, parents/guardians and are asked to give consent for the taking of photographs and recorded images. Consent may be withdrawn at any time by contacting the church.

I give permission for my child to be included in any photographs or videos which may be taken during Tots. Photos may be used in church publications, the church website and the church social media *
I am happy for a short text from Richard on a monday as a reminder of Tots events? *
GDPR:
ASC Belfast is committed to protecting your personal information.

By giving your consent, you are agreeing to allow us to hold and process your data for the purpose of contacting you with regards to up coming events run by our church for children and young people.
Please let us know if you agree for us to contact you about future events for children and young people, and events in the life of our church. *
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