Consent Form

Consent form for Children and young people taking part in King’s Church activities

To be filled in by a parent or guardian. Note: Please complete one form per child

Name of Child: ___________________________________________

Age of Child:______________D.O.B__________________________

Name of Parent or Guardian:__________________________________

Address

Home Tel: ……………………………………………….Mobile:……………………………………………………………

Email:

Emergency Contact Number…………………………………………………………….Relationship to child……………………………………………………..

2nd Emergency Contact Number………………………………………………… Relationship to child……………………………………………………..

Any medical conditions/ behavioural needs/ allergies/ toileting instructions you would like to inform us about?

__________________________________________________________________________

__________________________________________________________________________

Consent for attendance:

I give my consent for (name of child)____________________________________________ to attend Kings Club.

Signed:_________________________________________________________Parent/ Guardian. Date ……………/………………../…………………/

* * * * Please print this form and bring it with your child/young person * * * *