Youth Ministry Consent Form 

Young Person's details
Name: 
Date of birth:
Gender: 
Male
Female
Other
Address:
Home phone number (optional):
Mobile phone number (optional):
Email address (optional):
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:
Would you like to receive email updates about youth activities at Cambourne Church? This will add you to the mailing list for updates from the youth worker/ youth 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

If you will be aged 13 or over during this academic year we need your permission for the Church Council of Cambourne Church, and those whom the Church Council have authorised, to hold and process your personal data. Please type "I agree" below to confirm your agreement with this.
This basically means that we will be able to store your details on our computer systems, share them with other people who help run youth activities, and use them to keep in touch with you (if we've also been given permission by your parent or carer).


Details of Parent/Carer 1
Name:
Relationship to young person:
Home phone number:
Mobile number:

Email address (optional):
Would you like to receive email updates about youth activities at Cambourne Church? This will add you to the mailing list for updates from the youth worker/ youth 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
Name:
Relationship to young person:
Home phone number:
Mobile number:
Email address (optional):
Would you like to receive email updates about youth activities at Cambourne Church? This will add you to the mailing list for updates from the youth worker/ youth 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

Please ensure that permission has been given by the people named above as emergency contacts for the details to be held and processed by Cambourne Church.
I confirm that this permission has been given

Parent/Carer's Consent
This section gives various permissions relating to the young person named on this form. It should be filled in by someone with legal parental responsibility for the young person.
Communication with young people, and 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 youth activities in person and online, e.g. Xtreme, youth socials, etc. (understanding that separate permission will be sought for activities such as outings and residentials)?
Yes - in person and online
Yes - in person only
Yes - in online only
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
Do you give permission for your child/ward to be contacted by email?
Yes
No
Do you give permission for your child/ward to be contacted by phone (calling or texting)?
Yes
No
Do you give permission for your child/ward to be contacted by via social media network sites (e.g. Facebook, Instagram)?
Yes
No

Is there anything else of which the youth 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 leaders of this event 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 young person 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