Born For This Leaders Consent Form

Your Details

First name

Last name

Mobile

Please enter your mobile number with no gaps.

Parish/ Group you are attending with.

Do you suffer from asthma, allergies, diabetes,

epilepsy or and other medical condition that may affect normal

activity?

Yes

Please give details of condition & treatment.

Do you have any special dietary needs or food allergies?

Yes

Please give details

For example vegetarian, nut allergy etc

Next of Kin

Name:

Mobile Number:

Please enter the mobile number with no gaps.

Relationship to you.

CONSENT

The information you have provided in this form will be retained by the Kenelm Youth Trust. The information provided will be used for the purposes of communicating with you about the event you are registering for and other opportunities that might be of interest to you. This information will be stored securely for 3 years. If at any point you want this information deleted please email: kristi.doughty@kenelmyouthtrust.org.uk

I consent to my information being stored and used as detailed above

KYT send out email newsletters once or twice per month about opportunities for young people and those who work with them. It is one of our key ways of communicating the many great opportunities offered by the Trust. You can unsubscribe or change your preferences at any time.

Please sign me up to the monthly newsletter

Media Consent

I consent to photographs and video's being used to share about the work of the Kenelm Youth Trust and the Archdiocese of Birmingham on our websites, social media, publications and presentations.