PRAY FOR OUR TEENS
or if you prefer
download the consent form and send it back to Clotilde
at Ealing Abbey Pray for our Teens 2 Marchwood Crescent London W5 2DZ
or by mail
Your Name (required)
Your Email - if you use it-
Your phone number (required)
Your address (required)
Your Postcode (required)
Date of birth (required)
Next of keen name (required)
Next of keen contact details(required)
Other language(s) spoken
- I hereby consent to Pray for our Teens using the above information for their stated purpose. In addition, I hereby consent to members of Pray for our Teens visiting me should I be admitted to hospital. I further confirm that I will keep confidential any information about any individual that I receive from Pray for our Teens. I understand that Pray for our Teens will comply with the provisions of the Data Protection Act in holding this information.
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Please indicate which is the largest number, 2 or 8 ? (required)
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