Called to Serve: Altar Servers' Retreat- 18 and over consent form.
Your Details
First name
Last name
Email
Mobile
Emergency Contact Details
Please provide details of a person to be contacted in case of an emergency.
Emergency Contact Name
Emergency Contact Mobile
Relationship to you.
Your details
Date of Birth
dd/mm/yyyy eg: 21/03/2010
Sex
Male
Female
Year Group
Year 13
Not applicable
Can you ride a mountain bike?
Yes
No
House name/Number and Street
City
County
Postcode
Do you suffer from asthma, allergies, diabetes,
epilepsy or and other medical condition that may affect normal
activity?
Yes
No
Please give details of condition & treatment.
Do you have any special dietary needs or food allergies?
Yes
No
Please give details
For example vegetarian, nut allergy etc
Your Details
Are you attending the Altar Servers' retreat as a Leader?
Yes
No
Do you hold a current DBS?
Yes
No
Please provide your DBS Number
Please contact your Parish Safeguarding person to obtain a DBS.
Your Parish
Name of your Parish
Name of your Parish Leader
Parish Leaders email
Parish Leaders Mobile number
CONSENT
The information you have provided in this form will be retained by the Kenelm Youth Trust (Charity Number
1144209) and shared with the Archdiocese of Birmingham ( Charity Number234216) and
the group leader of your youth group and used for the purposes of communicating with you about the event you are registering for and other opportunities that might be of interest to you. This information will be stored securely for 3 years. If at any point you want this information deleted please email: kristi.doughty@kenelmyouthtrust.org.uk
I consent to my information being stored and used as detailed above
KYT send out email newsletters once or twice per month about opportunities for young people and those who work with them. It is one of our key ways of communicating the many great opportunities offered by the Trust.
You can unsubscribe or change your preferences at any time.
Please sign me up to the monthly newsletter
Media Consent
I consent to photographs and video's being used to share about the work of the Kenelm Youth Trust on our website, social media, publications and presentations.
If an error code appears and stops the form from being submitted, p
lease email kristi.doughty@kenelmyouthtrust.com who will be able to assist you.