Holiday Bible Club & Pathway Club Consent Form

Holiday Bible Club 19-23 August 2024, 6:30-8:15pm
Pathway Club 2024-2025 Friday evenings 6:45-8:00pm

Child's Full Name:

Full Address:

Postcode:

Date of birth

YYYY

Age:

(Home) Phone Number to contact in an emergency:

(Work) Phone Number to contact in an emergency:

(Mobile) Phone Number to contact in an emergency:

If unavailable, alternative emergency contact person's name:

Alternative emergency contact person's phone number:

Relationship to child:

Name of Child/Young person's GP:

GP's Surgery:

GP's Tel no:

Details of known conditions - allergies, asthma, diabetes, epilepsy etc and any medication being taken:

Any other special needs, requirement or information that would be useful to leaders to know about:

I agree to the following:

I will inform the leaders of any important changes to the details above.

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 necessary, or for medical treatment to be administered by a suitable qualified medical practitioner

If I cannot be contacted and my child should require emergency hospital treatment, I authorise an adult leader to sign on my behalf any written form of consent required by the hospital. However, I understand that every effort will be made to contact me as soon as possible.

I CONFIRM THAT ALL THE ABOVE DETAILS ARE CORRECT TO THE BEST OF MY KNOWLEDGE

Parent/Guardian Name Printed In Full:

Date Signed:

YYYY