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Parental Consent Form

C.C.C.G

12, Quarry Street

Coatbridge

ML5 3PU

Kids Summer Sessions 2025

Parental Consent Form

Child's Full Name*

Date of Birth*

Day

Month

Year

Gender

Adress

Country/Region

Address

City

Zip / Postal code

Parent/Guardian Name(s)*

Emergency Phone Contact*

Doctors Name

Doctor's Contact Number

Parent/Guardian Contact Email*

Session 1. Dance & Exercise 3rd July

Session 2. Cooking & Nutrition 10th July

Session 3. STEM science 17th July

Session 4. Petting Zoo 24st July

Session 5. Yoga & wellbeing

31st July

ALL OF ABOVE

Does your child have any medical conditions? If yes, please specify:

Is your child currently taking any medication? If yes, please specify:

Does your child have any allergies (food, medication, etc.)? If yes, please specify:

Please provide any dietary requirements or restrictions for your child:

Does your child have any additional support needs (ASN) or special requirements? If yes, please specify:

In case of emergency, I authorize the organisers of the summer program to seek medical treatment for my child if deemed necessary. I understand that every effort will be made to contact me or the emergency contact listed above in such situations.

Next of Kin Contact Information:

Next of Kin Full Name*

Relationship to Child

Contact Number*

Photo Consent:

I give permission for my child to be photographed and recorded during the summer club activities. These may be used for promotional purposes, including social media, the organisation's website, and other materials.

Parental Supervision and Pick-up Time:

Parents are welcome to stay and sit in the community cafe. If a parent chooses to leave their child unsupervised, they must ensure that their child is picked up by the agreed time of 1:00 PM.

I understand that it is my responsibility to inform the organisers of any changes to the information provided in this form. CCCG do not take responsibility for child/children’s personal belongings. We advise to have name labels on any personal items.

To confirm compliance of above:

Date*

Parent/Guardian Signature*

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Cliftonville & Coatdyke Community Group

Connecting Communities, Creating Growth

Coatbridge Community Stadium

12 Quarry Street, Coatbridge, ML5 3PU, United Kingdom

admin@cliftonvillecommunity.co.uk

01236 428641

Charity Number SC050029

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Opening Times 23rd Jun- 10th Aug
Monday - 9.30am - 9.30pm
Tuesday - Class times vary
Wednesday - 10am - 7pm
Thursday - Class times vary
Friday - 10am - 2.30pm

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OSCR

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