Parental consent form for Energize activities
Thank you for encouraging your child to take part in Energize! We are thrilled that they are getting involved. To ensure we follow your wishes and keep your child safe, we ask for key details and also ask whether you agree/disagree with several statements.
* Required
Email address
*
Your email
Key information
Name of child
*
Your answer
Age of child
*
Your answer
I confirm I am the legal parent/guardian of of this child and I am over 18.
*
Yes
Required
Parent/guardian name
*
Your answer
Relationship to child
*
Your answer
A phone number we can contact you on
*
Your answer
Your full address
*
Your answer
Consent information
Please tick the statements which apply to you.
Which club would you like to sign your child up to?
*
Navenby (Monday)
Sincil Bank (Monday)
Croft Street (Tuesday)
Waddington (Tuesday)
Hykeham (Wednesday)
Waddington (Thursday)
Moorland (Thursday)
Waddington October Scheme
Birchwood October Scheme
Other:
Required
I give permission for my child to attend Energize holiday trips (we will let you know about these in advance)
*
Yes
No
I understand that Energize cannot take responsibility if my child does not abide by Energize's rules
*
Yes
Required
I am happy for my child to appear in promotional photos and/or videos
*
Yes
No
I am happy for my child to go home:
*
At any time (please note once signed out of the activity Energize cannot take responsibility for any child)
Only at the end of each session
When picked up (please note the name of the person picking up in the below question)
If you chose 'when picked up' to the previous question, please note the names of those picking up your child from the activity:
Your answer
Please note any medical conditions, special needs, illnesses or dietary requirements for your child:
*
Your answer
Data Protection
The following questions are to ascertain your consent for us to use your data. Information on how your details are used, how we maintain the security of your information, and your rights to to access information we hold on you (should you consent) is available in our full privacy statement to be found at
actstrust.org.uk
.
Acts Trust takes your privacy seriously, we will only use your information to provide our services. We also like to send information about our projects, events, and volunteering opportunities. If you agree to be contacted in this way, via any of the following methods, please tick the relevant boxes:
Email (our preferred method, it's the most environmentally friendly!)
Phone
SMS
Post
Acts Trust was founded by Alive Church, and we work closely together. We would like to share your information with Alive Church so that they may send you information about their services and events.
*
Yes
No
Send me a copy of my responses.
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