Youth Group Permission Form • Guildford Anglican

Youth's Details

Given Name *

Family Name *

Gender

Home Address *

Suburb *

Email Address

Date of Birth

School

School Year *

Mobile Number

Parent / Caregiver Details

Parent / Caregiver 1's First Name *

Parent / Caregiver 1's Last Name *

Parent / Caregiver 2's First Name

Parent / Caregiver 2's Last Name

Parent / Caregiver 1's Mobile Number *

Parent / Caregiver 1's Email

Parent / Caregiver 2's Mobile Number

Does either parent attend church, if so where?

Medical and Care Information

Does your youth have any allergies, medications or special diets? *

Does your youth have any activity restrictions or behavioural Issues?

Restrictions

Is there anyone who is legally restricted from seeing your youth?

Name/Details

Photos/Videos of my youth may be displayed and used to promote the group. *

Yes

Permission

I permit my youth to participate fully in the activities of Guildford Youth (GY) *

I give permission for my youth to travel in a car driven by an approved GY leader or a parent approved by a GY leader unless I advise the GY leaders otherwise. (Your child will not be in a car driven by a learner or provisional licence holder). *

Yes

I give permission, in the case of a medical emergency, to the doctor chosen (either by the church authorities or other persons supervising or administering the activities), to secure proper treatment for and/or order hospitalisation, injection, anaesthetic or surgery for my youth as named. I understand that every effort will be made to contact me prior to instituting such procedures. *

Yes

Signature

Date

Name Signed

The leadership team of Guildford Youth will treat the information contained confidentially. This information may be shared with a third party when it concerns medical health or care of the individuals listed. If you wish to access this information or have any queries in relation to the manner in which we handle your personal information, please do not hesitate to contact us.