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Parental Consent For YC

The document is a parental consent form for a child named [name] to attend a Jesus Youth UK retreat from April 13-15, 2012 at St. Joseph's Church in Sunderland. It requests medical, dietary, and allergy information about the child and signatures from both parents to acknowledge their agreement for the child to participate and adhere to the code of conduct. The form must be returned by the start of the retreat for the child to attend and is required for all unaccompanied participants.

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40 views2 pages

Parental Consent For YC

The document is a parental consent form for a child named [name] to attend a Jesus Youth UK retreat from April 13-15, 2012 at St. Joseph's Church in Sunderland. It requests medical, dietary, and allergy information about the child and signatures from both parents to acknowledge their agreement for the child to participate and adhere to the code of conduct. The form must be returned by the start of the retreat for the child to attend and is required for all unaccompanied participants.

Uploaded by

jenijoseph28
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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PARENTAL CONSENT FOR RETREAT 2012

Name of the group: Jesus Youth UK, 11 Shottens Close, Leicester LE4
0QB
Programme: Retreat 2012
Date: 13th April to 15th April 2012
Venue: St. Josephs Church, Millfield, Sunderland, SR4 6HP.
We / I agree, our/my child........................(Write
childs full name) taking part in the Retreat organised by Jesus Youth. We / I
acknowledge the need for responsible behaviour - which is mentioned in the code of
conduct - from my child during the days of the programme.
Medical / Dietary information about your child
a) Is your child on any medication at present: Yes.No
If yes please give brief details:

.
b) Is your child allergic to any food? Yes

No

If yes tell us what they are...........


c) Does your child have any special dietary requirement? Yes
If yes what are they? ..................

No.

e) Is your child allergic to any medication? Yes No


If Yes please give brief details

Name of childs father: .


Signature
Home Address: ..
. ..
.
Phone: (Home).
(Mobile)
Name of childs mother:
Signature: ..
Home address if different from above..

.
Phone: (Home)..
(Mobile) ..
Please note the following:
Please fill the form and send it back through your child or
contact person on or before the programme. It is absolutely necessary that
we have this form before your child starts for the programme.
This form is needed for all the participants if they are not accompanied by their
parents or a close family member.
If you want to give any other information around the health or the well being of
your child which you think useful please write them in the space provided
below.
Any Other information: ..................................................................................................

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