Rooted Youth Digital Contact Form

YOUTH GROUP PERMISSION FORM: ROOTED

Hello! We look forward to welcoming your child to the youth group for this academic year. Please take a few minutes to fill in the following information so that we can make sure our records are up to date. All meetings, whether in smaller groups in homes and in public places, will be done with your child's safety in mind. All our leaders have PVGs and our safeguarding guidelines can be found on the Cornerstone website here.

* Indicates required field

Full name of young person *

Name of parents *

School year for 22/23 (between P7-S2) *

Contact Email for all correspondence *

Address *

Telephone Number *

Please give details of any medical/ behavioural conditions & dietary requirements we need to be aware of: *

I give my permission for my contact information to be used to regular communication regarding news, events, or changes concerning the youth group *

Yes No

I give my permission for the above named child: To attend the youth group and on occasion meet in smaller groups that keep with our safe guarding guidelines. To receive, in the event of an emergency and/or if I cannot be contacted, necessary hospital or dental treatment, including anesthetic, and for medication to be distributed as necessary. *

Yes No

I also give my permission for the above named young person. To have their photograph taken for church reporting or promotional purposes. *

Yes No

Finally, please include emergency contact details if they are different from the above:

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Printed Name of Parent/Guardian *

Date *

Submit

Digital Youth Permission Form

YOUTH GROUP PERMISSION FORM: ROOTED