Bolder Consent and Registration (Cornerstone Liverpool)

Please complete this form for your child(ren) attending Bolder.

Your name *

Last name

Email address *

Household members

Please complete the information requested below for all children attending Bolder. You don't need to fill out the 'Add Adult' section as we have already collected this information from you, unless you would like to add the details of another adult from your household.
For each child of Bolder age, please click 'Add child' to fill in their details. In the medical notes section, please include any educational needs and/or dietary requirements as well - anything it would be helpful for the Bolder team to be aware of, or if there is nothing we need to be aware of please write 'none'.

Phone number *

Phone type

Parent/Carer’s Address: *

Please include the postcode.

Name of your child(ren)'s GP, GP Surgery, address and phone number: *

In the event that you are unavailable or uncontactable, please provide the details of an emergency contact other than yourself:

Emergency Contact Name: *

Emergency Contact Phone Number: *

Relationship to your child(ren): *

I give consent for my child to be released to this person in the event of an emergency or illness if I cannot be contacted or am unavailable. *

Consent to participate in Bolder

I give my permission for my child(ren), named on this form, to participate in all Bolder activities *

Yes

Emergency and Medical Consent: *

I agree for my child to be given first aid by a trained member of the Bolder leader team if necessary. This includes applying plasters and the administration of any medication specified above.

In the event of an emergency, where I cannot be contacted, I agree for my child to receive urgent dental, medical, or surgical treatment, including anaesthetics, as may be considered necessary by the medical authorities present.

I agree to my child’s information being shared with the NHS and/or other relevant professionals in the case of an emergency.

I agree to inform Cornerstone Bolder leaders of any important changes to my child’s health, medication, or needs, and also of any changes to the personal information provided above.

Personal Information Consent

Photography and Video Consent *

I agree to photographs and short videos of activities including my child to be taken for use within the church community and for occasional publication including print, social media an/or website in accordance with the Cornerstone Collective Privacy Notice.

Yes

Further photography/video consent *

A leader can’t always prevent young people from taking photos/videos. If there’s a safeguarding issue with capturing/broadcasting of photos/videos of my child then I’ll alert the Bolder leaders, allowing them to pass this information to kids in Bolder.

Please confirm you have read and understood our Privacy Notice *

Respecting you and the data you share with us is really important to us. At all times we will endeavour to respect your information and keep it safe. By ticking this box, you consent for Cornerstone Collective of Churches to store your information. The Privacy Policy is located in the footer of the church webpages.

I agree for the Cornerstone Collective to use my data and contact me about any news, events and activities *

Yes

If you have any further information you would like to provide to the Bolder team, or you have any queries, please get in touch at bolder@cornerstonechurchliverpool.org.

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Cornerstone Collective of Churches
info@cornerstone-collective.org