Social Parental/ Guardian Consent Form
If you are a parent or guardian of a child under 18yrs old the form below must be filled out in full and brought to any social activity organised by Christ Church Clifton. Thank you.  
Activity:    Quantum of Solace Cinema Trip                                          Date of Activity: 1st November 2008
Venue:  Vue Cinema, Cribbs Causeway, Bristol (near the Mall shopping centre)
 
Transport: make your own way

Cost: £8 (per pre-booked ticket. Excludes any food or drink you want to buy)
 
Time:  tbc
Please bring: money to reimburse leader for ticket & money for food/ drink
Name of child:                                                                             Age:                                         D.O.B:

Address:                                                                                     Home Tel: 

                                                                                                  Mobile:

 

Does your child have any medical conditions we should be aware of?    YES/NO (if yes please state what they are) 

 

Is your child taking any medication? YES/NO (if yes please state the full name of the medication)

 

Doctors Name & Address:                                                               Tel:

 

 
Emergency Contact Details (Name, Address & Tel):

 

 
 
I hereby give permission for my son/daughter named above to take in the said activity under the supervision of the leaders and for any photographs and video material taken during the activity to be used for future publicity. In case of illness or accident I authorise...

1) The leader of the activity to sign on my behalf any written form of consent required by medical authorities if a delay in obtaining my signature is considered inadviseable or unecessary by the doctor or surgeon.

2) The leader to administer prescribed and non-prescribed medication

Signed:

Name:                                                                                            Date: