2024/25 Children & Youth Ministry Consent Form

* Indicates required information

Please indicate which ministry your are registering for:

Sunday Morning Kids Kid's Connection (age5 - Gr 5) Live Wire (gr 6 - 8) Pulse Youth (gr 9-12) 2024 Kids Christmas Drama Presentation

Parent/Guardian's Name 1

Parent/Guardian's Email 1

This address will receive a confirmation email

Parent/Guardian's Phone 1

Cell Home

Parent/Guardian 1 - Phone

Address 1

Parent/Guardian's Name 2

Parent/Guardians Email 2

Parent/Guardian's Phone 2 Cell Home

Parent/Guardian's Phone 2

Is there anyone who is NOT authorized to pick up your child?

Yes No

If you answered Yes above what is that persons name?

Child's Information

Name

Child's Date of Birth (dd-mm-yyyy)

Current School Grade

List any Allergies:

Health Card Number (Optional)

In case of emergency contact name.

Emergency Phone Number:

Does your Child have any physical, emotional, mental, behavioural concerns or limitations that staff should be aware of?

Yes No

If yes, please explain:

Is the Child bringing any medication with him/her?

Yes No

If yes, please list:

Explain how the medication is to be administered in detail. Please note medication must be in original packaging.

Live Wire / Pulse Youth Only

I give permission for my child to be driven to and from local ECC events or as an emergency to the child's residence. All drivers are screened and appropriate licenses.

Yes No Not Live Wire/Pulse Student

Consent Form

Information received is confidential and is being gathered for the purposes of serving your Child while in the care of Evangel Community Church. Any medical information collected here serves to authorize Evangel Community Church, and its staff and volunteers, to obtain medical assistance in emergencies as well as to assign the student to the appropriate classes, to develop and nurture ongoing relationships with you and your Child, and to inform you of program updates and upcoming opportunities at our Evangel Community Church. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish Evangel Community Church to limit the information collected, or to view your Child’s information, please contact us.

The safety of your Child is our primary concern. Precautions will be taken for their well-being and protection. I/we acknowledge that joining in activities have some risks including coming in contact with viruses and other communicable diseases.

I/we, the parents or guardians named below, authorize Evangel Community Church Program Personnel to sign consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above.

I/we, named below, undertake and agree to indemnify and hold harmless Program Personnel, Evangel Community Church, and its Leaders from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Evangel Community Church, as well as of any medical treatment authorized by the supervising individuals representing the Evangel Community Church. This consent and authorization is effective only when participating in or traveling to events sponsored by Evangel Community Church.

I/we acknowledge and give permission for photos or video to be taken during events that my children are participating in for the purpose of, but not limited to brochures and promotional material, websites, social media, newsletters or church edification. I also acknowledge and agree that Evangel Community Church will not post any names in the above said media presentations for the protection of all children, vulnerable persons and ministry volunteers.

We, Evangel Community Church, may on occassion send communication via email regarding program changes.

I have read, understood and agree with the above.

By entering my name in the space below, I confirm that I am a parent/guardian for the above mentioned child and I give permission for my child to attend Evangel Community Church Programs.

Parent Signature:

Date:

2024/25 Children & Youth Ministry Consent Form

Description

Please Fix the Following