Children's and Youth Work
Child's First Name:
Date of Birth: Gender:
School Year (as of September 2022):
Emergency Contact Numbers
1. Name of Contact: Relationship to Child:
2. Name of Contact: Relationship to Child:
Please give details of anything we need to be aware of:
Medical Conditions (e.g. Asthma)
Allergies/Dietary (e.g. Hayfever)
Behavioural needs to be aware of (e.g. Autism, ADHD) and then please contact Nic Bianchi as to how we may best support your child.
Permission to attend
I give permission for my child to attend groups on Fridays and/or Sundays which may include visits to local places (e.g. Cheam Park or trips to London etc.), or other events further afield.
Please note: This form is intended to give us permission, with your consent, to take your children to local and other events. The intention is that you won’t have to duplicate consent forms, but give your permissions all on this one form. Obviously we will let you know when we intend on taking them on trips – so please do ensure we have your full contact details in order to be able to do that.
How Cheam Baptist Church handles information about you and your child.
Information about you and your child in this form will only be used for keeping a record of and managing your child’s involvement with CBC’s children's and youth activities. This information will be kept confidentially and securely, and may be disclosed outside of CBC but only with your consent and with appropriate safeguards.
Information on this form will be kept on CBC’s records only whilst your child attends CBC’s youth activities and will be deleted from CBC’s records as soon as possible after your child ceases to attend.
The information in this form may be used to contact my child, if they are 15years old and over only, about any youth events or activities via Facebook/text or other media.
Photographs/video footage of my child may be used in displays in the church buildings, in presentations of the church youth work or on the church website.
You have the right to withdraw your consent to CBC’s handling this information at any time, a free right of access to any information about you kept by CBC, the right to have information about you kept by CBC deleted, corrected or restricted to a specified purpose at your request, and the right to complain to the UK Information Commission if you believe that CBC has misused any information about you.
I consent to information about me and my child being handled by CBC as outlined above:
If you have any questions please contact Nic Bianchi by
telephone: 020 8642 5070