YouthWave Consent form 
Please complete this google form to give your child consent to attend YouthWave programmes. This form also includes a section about your child's medical history. Please complete this section to ensure your child's health can be taken care off whilst under YouthWave's care. 
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Please scan the QR code to complete the YouthWave consent form digitally if you have received a paper version. Alternatively, scroll down to complete the digital version. 
Name of child  *
Date of Birth  *
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Address  *
Child's contact number:
Parent/Carer contact details 
Name of Parent/carer  *
Email *
Contact number of Parent/Carer *
Address (If different to child)
Do you give permission to be added to a parents groupchat? *
Alternative emergency contact name: *
Contact Number  *
If you do not have parental responsibility of the young person (e.g you are a foster carer/grandparent etc), please provide details of those with parental responsibility including: Name, relationship to young person, contact number and address. 
Medical Information 
Does your child have any allergies/medical requirements? *
If yes, what are these medical requirements? 
Do you give consent for the appropriate medication to be given to your child in the case of an emergency?  *
What is the name and address of your child's GP? *

I understand that while involved he/she will be under the control and care of the group leader and/or other adults approved by the place of worship/organisation leadership and that, while the staff in charge of the group will take all reasonable care of the children, they cannot necessarily be held responsible for any loss, damage or injury suffered by my child during, or as a result of, the activity.

Whenever medical advice or treatment is needed, the assistance of a GP or A&E Department of a hospital should be sought.  The Children Act 1989 allows a doctor to provide any necessary treatment by doing ‘what is reasonable in all the circumstances of the case for the purpose of safeguarding or promoting the child’s welfare’.

However, the parent/carer should be contacted and advised of the situation as soon as possible.  It is important, however that those caring for children and young people on day trips, outings and residential activities obtain in advance, the following from the parent/carer:

1.        All necessary information concerning the child/young person’s health, allergies, medication etc.

2.        Written agreement as follows:

 I understand:

·               My child will receive medication as instructed before or during the event.

·               Every effort will be made to contact me as soon as possible should my child become ill or have an accident.

·               My child will be given medical/dental treatment as necessary.


Do you give permission for your child to travel by themselves to and from Youthwave events? *
If no, what are the alternative travel arrangements?
Do you give permission for your child to travel with a leader when relevant? This may be by public transport or car etc *
Do you give permission for your child to attend YouthWave related events? This may involve visiting other youth events or Connex groups etc *
Communicating with children and young people
Children and young people communicate via telephone, mobile, email and the internet
Do you give permission for children/youth workers to communicate via these methods to your child?  *
I give permission for my child to be communicated with via  *
Do you give permission for your young person to be posted on our social media platforms?(e,g YouthWave website or Instagram) *
Sign below Parent/adult with parental responsibility  *
Date: *
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The information requested on this form can be completed by a carer, but only those with parental responsibility can sign the consent (NB: This may not include a foster carer). If you would like to withdraw consent or have any further questions about the information we hold about you, please contact Victoria Brown [youth worker] on _Youth@ecci.org_or _02085093128_

Produced on behalf of Youthwave, Emmanuel Community Church International
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