Altar Server Application/Consent Form

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Oct 31, 2013 (3 years and 8 months ago)

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Child Safeguarding and Protection Service


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1

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Archdiocese of Dublin


Altar Server Application/Consent Form

Parish of ____________________
______________
_


(All information will be treated in confidence)



Applicant
Name:

_
__________________________________

Date of Birth:
_______________________________________

Address: _____
______________________________________

__________________________________________________________________

Parent/Guardian Name: _____________________________________


Parent/
Guardian
-

Telephone

Contact Number: _____________________
Parent/
Guardian
-

Mobi
le Contact
Number:


_____________________

Other Emergency Details
-

Name _
____________________

Home Telephone Number: __________________

Mobile Telephone _______________________________________________



Child Safeguarding and Protection Service


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Archdiocese of Dublin



Does your child suffer from any medical condition
, disability or allergy
Yes/No

Please give details
below (
If necessary please attach note
)
_
______________________________________________________________

__________________________________________________________________

Consent:

I give consent for my c
hild _________________
______________________
__

to be trained and participate as an altar server in the parish of
__________________________________________________________________

Signed: ______________________________________________

Date: ______________
________





Child Safeguarding and Protection Service


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Archdiocese of Dublin




Permission for Medical Care:

In the event of my child being taken ill or injured during his/her time serving
at Mass,

if any surgical operation or injection becomes urgently necessary, I
hereby authorise the leader in charge to sign on my be
half any written forms
or consent required, provided that the delay necessitated to obtain my
signature or parents signature might endanger or worsen my child’s health or
safety.



Signed: ______________________________________________

Date: ___________
____________________________











Child Safeguarding and Protection Service


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4

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Archdiocese of Dublin


Special Altar Server Consent Form


I __________________
____
_, parent/guardian of __
____
______________,

give permission to his/her class teacher to excuse him/
her from

class to
serve Mass in


________________
____
_________________

Church

on ____________________
____________
__ (Day/Date).

Please tick and complete one of the following:


My child will be co
llected by ___________________

or


I give permission for my child to make his/her own way to the
church.

Signe
d: ______________________________


Date: _______________

Contact Details of Parent______________________________

____________________________________________________________