Crossover / Youth Café Registration & Consent Form 2022/23

Crossover / Youth Café Registration & Consent Form 2022/23

Torrance Parish Church
Child's Full Name *

First Name Last Name
Child's Date of Birth *

Day Month Year
School Attended & Current Year Group *
e.g. Torrance Primary (P7)
Child's email
For use in online events. Zoom invites will be sent to this e-mail. If left blank, invites will be sent to parent / guardian e-mail instead
Any known allergies, disabilities or medical conditions *
Photographs and video clips may be taken during Crossover which may be used in the church magazine or newsletter, website or social media. Please indicate if you are happy for photographs / video of your child to be used in this way. Your child's name will not be used. *

Yes No
During Crossover, young people may be transported to outside events (under supervision) in leaders' or parents' vehicles. Please indicate whether a child car seat is required (under 12's only). *

Seat required Seat not required
Consent

I agree to my child taking part in Crossover events for this session (August 2022 to September 2023). I confirm that these details are correct to the best of my knowledge. I agree that I will read the e-mails giving details of each event carefully and that in sending my child I am in agreement with arrangements set out therein. In the unlikely event of illness or accident, I give permission for any appropriate first aid to be given by the nominated first-aider. In an emergency and if I cannot be contacted, I am willing got my child to receive necessary hospital or dental treatment including an anaesthetic. I understand that every effort will be made to contact me as soon as possible.
Parent / Guardian Full Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

Town/City

Post Code
Parent / Guardian's E-mail *
Home Phone Number

Area Code Phone Number
Mobile Phone Number *

Area Code Phone Number
Alternative / Emergency Contact
Alternative Contact #1 Name *

First Name Last Name
Relationship to Child *
Phone Number *

Area Code Phone Number
Alternative Contact #2 Name

First Name Last Name
Relationship to Child
Phone Number

Area Code Phone Number
I have carefully read this form, understand its contents, and agree to its terms and conditions. *

I agree
Signature *

Clear
Date *

Day Month Year
About Me

This section is both optional and confidential. Help us to get to know your child better, and to make Crossover as accessible and relevant for everyone as we possibly can. Fill in as much or as little as you want. You may wish to complete this section with the assistance of your child.
Things I am good at
Activities I enjoy
Something I'd like to do at Crossover
Things I struggle with or find difficult at times
How I want to be supported at Crossover
Torrance Parish Church is a Scottish Charity (SCO16058) and is part of the Church of Scotland. Our website is at www.torranceparishchurch.org.uk
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Crossover / Youth Café Registration & Consent Form 2022/23

Consent

Alternative / Emergency Contact

About Me