The Church of the HOLY APOSTLES
47 CUMBERLAND STREET
LONDON SW1V 4LY Tel. 020 7834 6965
PARENTAL CONSENT FORM
Name of candidate.…………………………………………...... Age…… Email…………………………………………………………………......
Parents’ mobile phone......
CONFIRMATION Programme 2017
I am willing to allow my child to take part in this programme. I realise that most of the 6 weeks that he/she attends, the group will be travelling to different venues, staying overnight for one night in Holy Apostles Hall and a one day retreat at Kairos Centre, Mount Angelus Road, Roehampton, London SW15 4JA 020 8788 4188
I am aware that part of the Kairos Day may involve, under the teams’ supervision of the Catechists, outdoor activities and I give my permission for my child to take part in these. As far as I am aware, he/she has not been in contact with any infectious diseases over the last three weeks and is in good health. I have made it clear to my child that he/she is not permitted to use cigarettes, alcohol or any form of drug or substance (apart from prescribed medical drugs) while taking part in this Confirmation programme.
I agree with the policy that all children will have to hand over their mobile phones to the nominated catechist on arrival for each session and these will be returned when the session is over.
He/she does/ does not* suffer from diabetes. He/she does/does not* suffer from epilepsy. (Any weakness or disability requiring special care or attention must be mentioned on the back of this form, as should any other relevant medical information, food allergies or dietary requirements.)
In the event of my child being taken ill or injured during the programme to the extent that a surgical operation or serum injection becomes necessary, I authorise Canon Pat Browne or his delegate should he not be around, to sign on my behalf any forms of consent requested by the medical authorities provided the delay required to obtain my signature might be considered likely in the opinion of the doctor or surgeon concerned to endanger my child’s health or safety. The person hereby authorised and any other adult accompanying the retreat shall not be under any liability as a result of the signing of this form of consent. I will indemnify them in respect of any claim by my child as a result thereof.
I understand that during the period of the programme my child will be under the supervision and instruction of the group leaders, and that whilst the leaders will take all reasonable care of my child they cannot be held responsible for any loss, damage or injury suffered by him/her arising during or out of the programme. The person hereby authorised and any other adult accompanying the programme cannot be held responsible for any loss or damage to personal effects. I will indemnify them against any claim instituted by or on behalf of my child.
My son/daughter was baptised at Holy Apostles approx______
My son/daughter was not baptised at Holy Apostles______
I attach their baptism cert______
I will let you have it next week. ______
Signed…………………………………………...... (Parent/Guardian*) Date…………….2017
The Parish Cost ifor running this course is approximately £40.00 per person. Everyone is asked to pay something within their means to this. Our donation for the Confirmation Programme is ...... Gift Aided? ......
Please return this form with the candidates application form on reverse side completed, to Patrick Huynh, the parish secretary at Priests’ House, 47 Cumberland Street, Pimlico, London SW1V 4Ly