Youth x Ya Worship Night • Green Pastures Church

Please update your young person's consent below for the youth and young adults worship night on Saturday 18 January.

First Name *

Last Name *

DOB (dd/mm/yyyy) *

Gender *

Young Person's Mobile Number

Home Address *

Home City *

Home Postcode *

Allergies/Medical Conditions/Additional Info

School Attended *

Class *

Parent/Guardian Name *

Parent/Guardian Mobile Number *

In order to ensure the safety of your young person while in our care, we require your consent for the following:

Permission for your young person to take part in the normal activities of the youth x ya worship night.
In the event of illness or accident, permission for the application of medical or first aid by appropriate persons.
In the event of your young person needing emergency hospital treatment, we will endeavour to contact you immediately.

*We would also ask that you ensure your young person is aware of their own travel arrangements prior to all youth events. Pick-up times will be communicated ahead of all events and we would ask that you collect your young person at that given time.

Please tick for consent for:

permission for photographs or videos of my young person to be taken for church use.

Parent/Guardian Signature *

Date (dd/mm/yyyy) *