Children's Ministry Consent Form 

Child's details
Child's full name: Date of birth:
Address:
Gender: 
Male
Female
Other
School attended (if applicable):
School Year (if applicable):
Name of GP surgery: 
GP surgery's phone number:
Any known allergies:
Any known medical problems or additional needs:
Any special dietary requirements:

Details of Parent/Carer 1
First Name & Surname:
Relationship to child:
Home phone number:
Mobile number:

Email address:
Would you like to receive email updates about children's activities at Cambourne Church?
This will add you to the mailing list for updates from the children's worker / children's work team
Yes
No
Would you like to receive email updates about wider Cambourne Church services and activities?
This will add you to the mailing list for updates from the church office
Yes
No


Details of Parent/Carer 2 OR Alternative Emergency Contact
First Name & Surname:
Relationship to child:
Home phone number:
Mobile number:
Email address:
Would you like to receive email updates about children's activities at Cambourne Church?
This will add you to the mailing list for updates from the children's worker / children's work team
Yes
No
Would you like to receive email updates about wider Cambourne Church services and activities?
This will add you to the mailing list for updates from the church office
Yes
No

Parent/Carer Consent
This section gives various permissions relating to the child named on this form. It should be filled in by someone with legal parental responsibility for the child.
The taking, storing and usage of photos/videos will conform to Cambourne Church's Photograph, Information and Communication Technologies Policy, which is available on request.

Do you give permission for your child/ward to attend Cambourne Church children's activities in person and online, e.g. Young Church, Gazebo, etc. (understanding that separate permission will be sought for activities such as outings)?
Yes - in person and online
Yes - in person only
Yes - in online only
No

For Under 5’s Only - Do you give permission for Young Church leaders to assist your child/ward with toileting when required? (NB – Parents/Carers will be asked to change soiled nappies) 
Yes
No

Do you give permission for un-named photos/videos of your child/ward (taken only by approved persons) to be used online (e.g. Cambourne Church website and social media)?
Yes
No
Do you give permission for un-named photos/videos of your child/ward (taken only by approved persons) to be used offline (e.g. newspaper/magazine articles, personal study/research, posters, etc)?
Yes
No

Is there anything else of which the Children's work leaders should be aware?

Declaration by parent/carer:
I certify that the information given on this form is accurate and there is nothing else of which the children's work leaders should be aware.  In an emergency, if I cannot be contacted, I am willing for my child/ward to receive necessary hospital treatment, including anaesthetic. I consent to the Church Council of Cambourne Church processing my personal data and that of my child/ward for the purpose of these activities. I confirm that I have legal parental responsibility for the child named here.
To confirm your agreement with this statement, please write "I agree" in the box below.


Please read the following before clicking 'Send' at the bottom of the page. 
A copy of Cambourne Church’s Safeguarding Policy is available to see on the church website www.cambournechurch.org.uk/safeguarding . It may be helpful for parents to know that the Church of England requires all those who work with children to report any obvious or suspected case of child abuse (which includes non-accidental injury, severe physical neglect, emotional and/or sexual abuse) to the relevant authorities. This is intended to protect children at risk and it is important to recognise that where there are grounds for suspicion, it is better to be safe than sorry. This does mean, however, that it is feasible for a case to be reported which, on investigation, proves unfounded. In the unlikely case of this occurring, it is hoped that parents, appreciating how difficult it is for the church to carry out this delicate responsibility, would accept that its workers were acting in what they believed were the child’s best interests.  

You can find out more about how we use your data from our “Privacy Notice” which is available from our website or from the Parish Office.
 
You can withdraw or change your consent at any time by contacting the Church Administrators at:
Cambourne Church Office, Jeavons Lane, Cambourne, Cambridgeshire, CB23 6AF
Email: office@cambournechurch.org.uk 
Phone: 01954 710644. 
 
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.
 
Cambourne Church is a Registered Charity, No. 1149312