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Please fill in the consent form below for each child attending Junior Church. This information will help us to provide the best possible care for your child on Sunday mornings.

JC Consent Form
Contact Details
Name of Child: Date of Birth:  
School your child attends: School Year:  
If the child does not live with the parents or other adults with parental responsibility, with whom do they live?
Name: Relationship to Child:  
Parent/Guardian Details
Name of Parent/Guardian:
Email Address:
Phone Number:
Parent/Guardian or Other Emergency Contact Details
This contact will only be used in an emergency if the parent/guardian cannot be contacted.
Email Address:
Phone Number:
Medical Details
Please give details of any health problems, medical conditions or allergies affecting your child, any medication that they are taking or any disabilities they have that may affect normal activity:
I give permission for a sticking plaster to be used on my child when necessary: Yes No
Other Information
If there is any other information not covered by this form that you feel is important for us to know please give details below:
I consent for my son/daughter to take part in the normal weekly activities of the group. I understand that the leaders will take all reasonable care in looking after my son/daughter but they cannot be held responsible for any loss or damage to property.
I understand that when my son/daughter is in church at the beginning and end of the Service they are my responsibility.
In an emergency, if I cannot be contacted despite all reasonable attempts to do so by the leaders, I give permission for my son/daughter to undergo emergency medical/dental treatment including the use of anaesthetics as considered necessary by the medical authorities.
I understand that this information will be kept whilst my son/daughter is part of Junior Church and will be destroyed after that unless it must be kept to conform with safeguarding regulations.
I consent to St Andrew's Church contacting me to keep me informed about events or activities linked with Junior Church.
We may use photographs and/or videos of children taking part in Junior Church in publicity for the group or for use in publicity, publications and websites produced by St Andrew's. No personal details, such as names, will appear with photographs or videos unless we obtain specific parental permission first.
I consent to photographs and/or videos of my son/daughter being used within St Andrew's for the purposes mentioned above.
Where you do not grant consent we will not be able to use your personal data except in certain limited situations, such as where required to do so by law or to protect members of the public from serious harm. You can find out more about how we use your data from our “Data Privacy Notice” which is available on our website or on the noticeboard at the back of church.
You can withdraw or change your consent at any time by contacting the Parish Administrator at administrator@standrewsashton.org.uk or by putting it in writing and giving it to Michelle Bateman.
Please note that all processing of your personal data will cease once you have withdrawn consent, other than where this is required by law, but this will not affect any personal data that has already been processed prior to this point.
Signed by parent/guardian:
St Andrew’s PCC is a Registered Charity, No 1163132