youth activity - Consent form



Event: Fireworks Night

Date: Saturday 5th November 2016

Venue/destination: Croydon Road Recreation Ground, Beckenham

Event details: We’ll be meeting for food at church at 7pm before heading down to the fireworks display at the park. After the display we’ll return to church for pickup. Food will be provided including hot dogs, drinks and other light refreshments.

Friends are very welcome, but everyone will need their own consent form to be completed by a parent or guardian to take part in this activity

Arival place and time: Citygate Church, 22 Rectory Road, 7:00pm

Return place and pickup time: Citygate Church, 22 Rectory Road, 9:00pm


Under 18’s - £5 cash entry to the fireworks display

(Adult helpers - £10)

Transport arrangements: Walking (10 mins)

Items to be brought: Suitable warm clothing and shoes


7.00pm - 7.45pm   Arrive and eat at Citygate

7.45pm - 8.00pm   Walk to Croydon Road Rec

8.15pm - 8.40pm   Fireworks display

8.45pm - 9.00pm   Walk back to Citygate and pickup

Please complete the consent form below

If you're signing up multiple children/young people please complete and submit one form for each person.

Name of child/young person *
Name of child/young person
My child/young person will be *
Consent *
Name of parent/guardian *
Name of parent/guardian
Date *

Whenever medical advice or treatment is needed, the assistance of a GP or A&E Department of a hospital should be sought. The Children Act 1989 allows a doctor to provide any necessary treatment by doing ‘what is reasonable in all the circumstances of the case for the purpose of safeguarding or promoting the child’s welfare’.

However, the parent/carer should be contacted and advised of the situation as soon as possible. It is important, however that those caring for children and young people on day trips, outings and residential activities obtain in advance from the parent/carer:

1. All necessary information concerning the child/young person’s health, allergies, medication etc.

2. Written agreement as follows:

I understand:

  • My child will receive medication as instructed before or during the event.
  • Every effort will be made to contact me as soon as possible should my child become ill or have an accident.
  • My child will be given medical/dental treatment as necessary.

Photography and filming of activities will be taken at this and future events and used by Citygate Church and Citygate Youth social media channels and other media. 

If, for any unforeseen reason, this activity overruns by more than 30 minutes, parents of young people making their own way home will be notified.

The information requested on this form can be completed by a carer, but only those with parental responsibility can sign the consent (NB This may not include a foster carer).