PARISH OF EAST HAM - [TEAM MINISTRY - CHURCHES OF]:
ST ALBAN'S • ST BARTHOLOMEW’S • ST MARY MAGDALENE]
PARENTAL CONSENT FORM – ST BART’S SUNDAY CLUB
Child/Young Person - details:
Name………………………………………………………………………………………………
Address…………………………………………………………………………………………..
……………………………………………………………………………………………………..
Telephone………………………………………………………………………………………
Date of Birth…………………………………..
Name and telephone number of emergency contact person………………….........
……………………………………………………………………………………………………..
Medical details
Do you suffer from any illness or condition that we should be aware of?
Yes No
If yes please specify ……………………………………………………………………….
Do you have any allergies?
Yes No
If yes please specify………………………………………………………………………….
Are you currently taking any medication?
Yes No
If yes please specify…………………………………………………………………………..
Name & Address of doctor
………………………………………………………………………………………………………
………………………………………………………………………………………………………
Dietary requirements/ vegetarian etc. ………………………………………………........
I am willing to allow my son/daughter named above to attend Stubbers and its programme of activities. I am willing to allow him/her to take part in the full programme of activities
In the event of any illness or accident requiring hospital treatment, I authorise a senior member of the St Bartholomew’s Sunday Club to sign, on my behalf any written form of consent required by the hospital authorities.
Relationship to volunteer…………………………………………………………………………………
N.B: if you are over 18 then please complete and sign it yourself.
[Alternatively the Parental Consent Form is also available from our downloads’ web site. Please highlight/copy and paste the following web site address to your browser and click ‘return’. The leaflet will automatically download to your designated area of your PC/Mac. The document is in Word .doc format]:-
For your further assistance and FAQ's. If you are still unclear or wish to clarify something please e-Mail us
We may also wish to use data you supply to us for the following purposes.
[ ] To send you further information about the St Bartholomew’s Church and its services/activities.
[ ] To pass to other organisations concerned with similar matters to yourselves, or third parties, e.g. other elected Officers of the Church responsible for such matters, or with agencies who require the same, albeit only when necessary and appropriate, e.g. where forms are completed for children’s/young people’s activities, the data will be provided to medical services/hospital where treatment is needed or accidents occur.
[Please tick the appropriate boxes if you do not wish us to do so]
Data Protection Act 1998
Please note that the information you provide on any form may be stored in a retrieval system. This information is treated as highly confidential and will be stored in a storage system. It will only be used for the communications with yourselves, (or in a way indicated above), and will not be made available to any other agency/organisation, unless the appropriate other boxes are ticked above.
