Berkshire Drive, Tilehurst.  0118 942 8632

Parental Consent

Church:   St Josephs                             Group:    Confirmation Class 2008/2009
Full Name of young person:                                                            
Date of birth:                                        School attended:
Address:

Details of any medical problems that we should know about:

Date of last anti-tetanus injection:

With whom does your child live (full names):
Telephone number:  Daytime:                                                             Evening:
    Other:

Email address (if in regular use):
    
Additional Contacts in case of emergency:
Name:                                                              Phone:
    

If you do not have parental responsibility, please provide name/phone numbers for anyone with parental responsibility.

IMPORTANT:  We expect children to remain in our care until they are collected.  However, please indicate if you are happy for your child to make their own way home or to be left alone if you are late. 
I give /  do not give permission for my child to make their own way home  (delete as appropriate)

Permission:
I give permission for  _____________________ to take part in the normal activities of this group including any retreat days and offsite activities such as bowling.   I understand that while involved he/she will be under the control and care of the group leader and/or other adults approved by the church and that, while staff in charge of the group will take all reasonable care of the children, they cannot necessarily be held responsible for any loss, damage or injury suffered by my child during, or as a result of, the activity.

In an emergency and/or if I am not contactable, I am willing for my child to receive necessary hospital or dental treatment including an anaesthetic.      YES   /   NO