Non-Residential in Loco Parentis youthwork form Big Questions? Consent form. A simple consent form for in loco parentis, non-residential Quaker youthwork Participant informationNamePrefered nameLocal Quakers Meeting (if applicable)Date of Birth Month Day Year Do we need to provide any extra help, for example because of a disability, or are there any activities that your child cannot participate in?Do we need to know about any medical conditions or allergies? (If yes, please provide details of the condition(s) and any medication needed).Is there anything else you think we should know?Parent Carer infoNameRelationship to Younger PersonAddress (if different from above)Email AddressMobile NumberSecond Emergency Contact PersonNameMobile NumberEmail AddressRelationship to childConsentsI agree toNote: if image consent is not given, Big Questions? York will not use any images taken during the activity that contain the child/young person. If you wish to withdraw consent please contact jonathonb@quaker.org.uk My child taking part in activities organised by Big Questions? Big Questions? keeping a record of this for for health and safety reasons Any medical treatment that my child may need to be given in an emergency My child being filmed or photographed during the activity, with the possibility that these photographs/media recordings may be used for publications or marketing publicity. (Quakers in London will take all steps to ensure these images are used solely for the purposes for which they are intended) Would you like to be contacted by email about future Quaker events and opportunities for children and young people? Yes No Would your young person like to be added to the Big Questions? (moderated and safegaurded) WhatsApp Youth Community? If so what is their mobile number. Yes No Great, what's thier mobile numberSigned...Your NameTodays Date Month Day Year
