Multi-Purpose Parental Consent Form

Anything written on this form will be held in confidence

The leaders need to know these details in order to meet the specific needs of your child

I give permission for my child to attend the organisations which I have marked below and to participate in all their activities.

Child's Full Name

Date of Birth

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name of parent/guardian to be contacted

Emergency Phone Number

Some of our organisations communicate with parents/guardians via a WhatsApp group. WhatsApp groups are administered by leaders within the organisation and are only for the purpose of communicating announcements or important information. If you would prefer not to be included in a WhatsApp group please tick this box.

I do not want to be included in a WhatsApp group

Alternate Emergency Contact

Name

Contact Number

Relationship to Child

Medical Details

Name of child's doctor

Doctor's Practice Address

Doctor's Contact Number

Details of any medical conditions or allergies leaders should be aware of including any medication needed while at the organisation

Details of any other particular needs your child has that leaders should be aware of

In the event of illness or accident, having parental responsibility for the above named child, I give permission for first aid to be administered where considered necessary by a first aider, if available, or medical treatment to be administered by a suitably qualified medical practitioner. In the event of a medical emergency, leaders will endeavour to contact you as soon as possible using the contact telephone numbers given. I will inform the leaders of any important changes to my child's health, medication or needs and also of any changes to our address or any of the phone numbers given above.

We, Ballylinney Presbyterian Church, are the data controller for the purposes of Data Protection Legislation. We require the following information from you to allow us to register your child. We are collecting this information to enable the church to run the events safely, allow for protection of your interests in respect of dietary and medical requirements, and ensure we can contact you (or other nominated adult) in case of an emergency. Data Protection Legislation allows us to process this information as we regard it as being in the church's legitimate interest. If you are unable to supply the information requested then we will be unable to accept your participation. You can withdraw consent at any time by contacting the Church Office (office@ballylinneypc.co.uk). Registered Charity in Northern Ireland - (NIC104716)

Organisations

Please tick all organisations your child plans to attend

Boys' Brigade *

Girls' Brigade *

Junior CE

Glow - Sunday School

Fusion - Youth Fellowship

Ignite - Sunday Bible Class

Catalyst - Youth Club

*Girls' Brigade. Annual company dues of £20 for each girl attending GB. This money is used to help cover insurance, activity costs and materials for the girls. Please pay by bank transfer to Ballylinney Girls Brigade Company (Danske Bank) Sort Code: 95 06 79; Account Number: 11 04 57 25 02. Please insert girls name in payment reference.

*Boys' Brigade. Annual company dues of £30 for each boy attending BB. This money is used to help cover insurance, activity costs and materials for the boys. Please speak to the leader in charge of the BB section your boy attends regarding payment of dues. Dues may vary depending on the number of boys from one family at BB.

During the time your child will spend with us, photographs may be taken for general church purposes and for this we need your permission. . If you would prefer for your child not to be photographed please tick this box.

I would prefer my child is not photographed