Portavogie & Cloughey CSSM Consent Form

  • Portavogie & Cloughey CSSM Consent Form

    To be completed by the child's parent/guardian.

  • Portavogie & Cloughey CSSM

    20 - 24 July 2026

     
    Please note that completion of this form is not considered a booking of your child's place. Completing this form will speed up the sign in process on your child's first visit. 

     

    Please complete one form per child.

  • Child's Information

  • Child's Section

    (Child's Age Group)

  • Medical Information

    The information you provide will be used to help keep your child safe and well during this SU Mission.  Those in leadership of the mission and each section will hold this information and, if necessary, it may be shared with other leaders e.g the first aider. In an emergency it will be shared with medical staff.
  • Medical Conditions*
  • Does your child carry an Epi Pen?*
  • Do you give permission for a trained first aider to administer your child's Epipen?*

  • Thank you for your response. The Team Leaders will be in touch to discuss the options for your child's involvement at this SUNI Mission.

  • Additional Needs and Support

    This information will be seen by the Team Leader(s) and Section Leader(s) and used to plan for all activities. It will only be shared, as necessary, with your child's Small Group Leader. In the case of an injury or emergency, medical staff will also be told this information. In the case where your child has additional needs we will make every effort to welcome them to our programmes however this may not always be possible due to volunteer availability and limited resources.
  • Should we be aware of any additional needs of your child?*

  • Learning Needs and Support

  • Does your child receive any support for additional needs at school?*

  • Physical Needs

  • Does your child have any physical disabilities?*

  • Speech and Behavioural Needs

  • Does your child communicate through speech?*
  • Does your child understand and respond to spoken word?*
  • Does your child have any problems with new situations?*
  • Does your child have any problems coping with new people?*
  • Which does your child prefer?*
  • Does your child have any specific behaviour issues? (For example, coping with correction, complying with instructions)*

  • Intimate Care Requirements

  • Is your child independent with toileting requirements?
  • Does your child require help with toileting?

  • By selecting 'Yes', you are giving permission for a team member to help your child with toileting and their personal care.

  • Getting to Know You!

    In order to help us ensure that your child's experience at this SU programme is the best it could be, we would love to know a little bit more about them! We would really appreciate information on the following areas where relevant.

  • Friends and Family

  • School

  • Likes and Dislikes

  • If you are filling out this form in advance of the mission, a member of the team will endeavour to be in contact before it starts, however, this may not always be possible.

  • Emergency Contact 1

  • Emergency Contact 2

    If we cannot contact the individual listed as Emergency Contact 1, we will contact Emergency Contact 2

  • Permissions

    I (having parental responsibility for the above named person) give consent and permission to the following:
  • Any emergency medical treatment that may be necessary during the duration of the SUNI activity.*
  • I give permission for my child to walk home alone.*

  • Thank you for your response. The Mission Leader will be in touch with you to discuss the options for your child's involvement at this SUNI activity.

  • I give permissions for photographs and video footage of my child/young person to be used on printed materials, on the SUNI webiste and/or on SUNI's social media accounts*

  • Data Protection

    The information you have given us in this form is held and used throughout the time of the activity. We do not share information with any other organisations unless there is a Safeguarding concern. For insurance reasons this information will then be securely archived. To find out more about how we use your information please visit our Privacy Policy - www.suni.co.uk
  • Can we contact you via email with information about the wider ministry of Scripture Union?

  • Authorisation

  • Date*
     - -
  • Should be Empty: