Consent Form • Christ Church Central • Sheffield

Forename:

Surname:

Date Of Birth:

Address:

Name of parent / carer:

Telephone number:

Email address:

GP name:

GP address:

GP telephone number:

Details of any medication, medical problems (e.g. diabetes, asthma, epilepsy), allergies, dietary needs or disability that may affect the child’s / young person’s normal activity:

In an emergency and/or if I am not contactable, I am willing for my child to receive doctor/hospital/dental treatment, including an anaesthetic.

Yes
No

I give consent for photographs of my child to be taken and used by Christ Church Central on the church website, on welcome boards/displays in the church building, or on a slide show for the church family.

Yes
No

I give consent for Christ Church Central to retain and securely store the data provided on this form in accordance with GDPR guidelines, and to use it to contact me regarding my child as appropriate.

Yes
No

Welcome