NEW SOUNDS CONSENT FORM 

Valid for New Sounds 2019 only

If you have any issues filling this form out then please email help@newlifechurch.me

Please enter your child's details below to allow entry to New Sounds 2019.

All information entered below will be held on record by New Life Christian Church and will be used for the purposes of safeguarding and for the health and safety of your child whilst on the New Life Christian Church premises. Unless you give us your written permission, we will not disclose the information provided by you below to third parties, except to medical professionals in the case of a medical emergency, and law enforcement agencies, if we are required to do so by law. We will remove your/your child's personal information from our systems on your written instruction to do so. Please contact privacy@nlccuk.org if you have any questions or concerns about our collection and use of your/your child's personal information, or if you would like your/your child's personal information to be removed from our database.

New Life Christian Church Trust is registered under the Data Protection Act 1998 as a Data Controller under number ZA310215. Our registered charity number is 275014.

Participants details

First Name:
Surname:
Date of Birth:
Address:
Name of Family Doctor:
Doctor's Address:
Doctor's Telephone Number:
   
If it is considered necessary, can the participant receive:  
Over-the-counter sting relief?
Mild painkillers (e.g. Paracetamol) being administered?      
 
Do you / Your child have any of the following?  
Asthma or Bronchitis
Heart Condition
Epilepsy, Fits, Fainting or Blackouts
Severe Headaches
Diabetes
Any recent contact with contagious diseases and infections?     
Other Illness or Disability
Allergies to any known drugs or medication?
Allergies to any food?
Any other allergies e.g. material, insect bites etc
Has the participant received vaccination against Tetanus in the last 10 years?
Is the participant receiving medical treatment of any kind? 
Has the participant been given specific medical advice to follow in emergencies?   
Is the participant currently taking any medication?  
Does the participant have any Special Needs, Learning Difficulties or Mental Health issues?
 

IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES PLEASE GIVE DETAILS BELOW.
Please include names and dosages of any prescribed medicines.

 
Condition or Disability:
*Treatment and/or Medication (inc. dosages):
Special Instructions:


*PLEASE BRING ALL NECESSARY MEDICATIONS showing Name and Dosage Details.
These must be handed in to the First Aider on site at time of Registration.
No medication of any type is to be retained by the participant. 

Ensure you complete the onsite medication doses form.  Without this signed form no medication will be administered. 

 

SPECIAL DIETARY REQUIREMENTS:  Please inform the Kids Church team with as much notice as possible.

 
I consent to the participant receiving any emergency medical treatment necessary during the course of New Sounds 201
 
 
I confirm the above information is accurate and complete
   
Parent/Guardian Name
Date Form Completed:
 

Emergency Contacts

Emergency Contact 1
 
Relationship to Participant:
Forename:
Surname:
Address:
Postcode:
Landline Number:
Work Number:
Mobile Number:

Emergency Contact 2
 
Relationship to Participant:
Forename:
Surname:
Address:
Postcode:
Landline Number:
Work Number:
Mobile Number:
 
  
I consent to photos or videos being taken of my child during the event to be used in conjunction with the promotion of future church events.
   
I consent to my, my child's and the emergency contact's contact details provided above being used for providing information about NLCC events and other relevant purposes by:  
Text Message  
Email  
Phone  
   
Parent/Guardian Name
Date:
By pressing 'Send' below I confirm that I understand and agree with the content of the form above, I accept the Terms and Conditions of Booking and that I am the parent / legal guardian of the participant