GP Kids Consent Form • Green Pastures Church

First Name *

Date of Birth *

Last Name *

Gender *

Home Address *

Home Address Line 2

Home City *

Home Postcode

Age Group/Class

Allergies/Medical Conditions/Additional Info

Parent/Guardian Name *

Mobile Number *

In order to ensure the safety of your child(ren) while in our care, we require your consent for the following:

Permission for your child(ren) to take part in the normal activities of this department.
In the event of illness or accident, permission for the application of medical or first aid by appropriate persons.
In the event of your child(ren) needing emergency hospital treatment, we will endeavour to contact you immediately.

Please tick for consent for:

Permission for photographs or videos of my child(ren) to be taken for church use.

Parent/Guardian Signature

Date