Go with Hope- Under 18 Consent Form
Parent/Guardian Details
The Parent/Guardian details provided will be used as the first emergency contact and to communicate about Go with Hope.
First name
Last name
Email
Mobile
Second Emergency Contact Details
Please provide details of a second person to be contacted in case of an emergency. We will attempt to contact the first emergency contact before using the second contact provided.
Emergency Contact Name
Emergency Contact Mobile
Participant Registration
Please provide the following details for each young person you are registering. To complete the registration details for more than one young person select "add another response" at the bottom of the box below.
Young persons details
First Name
Last Name
Date of Birth
dd/mm/yyyy eg: 21/03/2010
Name of your group
Please select...
Hagley High School
Perpetual Help Cluster Youth Group
Our Lady and St Werburgh's Youth Group
St Margaret Mary- Fr Simon Ellis
Bishop Challoner
Group not listed
Name of your group:
House name/Number and Street
City
County
Postcode
Does the participant suffer from asthma, allergies, diabetes,
epilepsy or and other medical condition that may affect normal
activity?
Yes
No
Please give details of condition & treatment.
Does the participant have any dietary requirements?
Yes
No
Please provide dietary needs here
Workshop Choices
There will be three workshops during the day. Please choose
four
that you would like to attend, and we will endeavour to accommodate your preferences.
First choice
-Care for Creation - Outdoors
-Poverty - SVP
-Praise - Music and Poetry
-Joy - Games and Challenges
-Art
-Prayer - Immersive mediation
-Fraternity - Looking at community in a Franciscan Lens
Second choice
-Care for Creation - Outdoors
-Poverty - SVP
-Praise - Music and Poetry
-Joy - Games and Challenges
-Art
-Prayer - Immersive mediation
-Fraternity - Looking at community in a Franciscan Lens
Third choice
-Care for Creation - Outdoors
-Poverty - SVP
-Praise - Music and Poetry
-Joy - Games and Challenges
-Art
-Prayer - Immersive mediation
-Fraternity - Looking at community in a Franciscan Lens
Fourth choice
-Care for Creation - Outdoors
-Poverty - SVP
-Praise - Music and Poetry
-Joy - Games and Challenges
-Art
-Prayer - Immersive mediation
-Fraternity - Looking at community in a Franciscan Lens
CONSENT
The information you have provided in this form will be retained by the Kenelm Youth Trust, shared with 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
In the event that I cannot be contacted by ordinary means, I give permission and consent for my child/young person to receive any necessary medical treatment and authorise the group leader/person in charge to sign any medical documents required by the hospital authorities.
I consent to my child/young person receiving necessary medical treatment in the event I cannot be contacted.
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
My child and 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.