Youth Ministry Registration and Consent 2020/2021

Basic Information

Parent/Guardian Name

This address will receive a confirmation email

Cell Phone

Home Phone

Address

Student's Full Name

Student's Phone

Student's Email

Student's Birthdate

Grade

Health Information

This medical information serves to authorize Oak Park Church of Christ, and its Staff and Volunteers, to obtain medical assistance in emergencies.

Alberta Health Card Number

Family Doctor

Allergies (If no, please put N/A)

Epi-Pen

Emergency Contact (Not Parent/Guardian)

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

Select One

Yes No

If yes, please explain:

Is your student bringing any medication, including inhalers, to Youth Group?

Select One

Yes No

If yes, please list with instructions for use.

The safety of your student is our primary concern. Precautions will be taken for their well-being and protection.

In the event of a medical emergency, I/we, the parents or guardians named below, authorize Oak Park Church of Christ's Pastors or Youth Ministry Personnel to sign a consent form 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, Oak Park Church of Christ, 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 Oak Park Church of Christ, as well as of any medical treatment authorized by the supervising individuals representing Oak Park Church of Christ. This consent and authorization is effective only when participating in or travelling to events sponsored by Oak Park Church of Christ.

Parent/Guardian Name (First and Last)

Communication

A policy is in effect that communication is to be used solely for the dissemination of information. Please check the boxes below to grant permission for Youth Ministry Personnel (staff and volunteers) to communicate with your child via telephone, email, social media, and/or text.

You May Select Multiple Options:

Telephone Email Social Media Text Messages None

Walking Home

By selecting "yes" below, I, the above-named parent/guardian, hereby give my child, the above-named student, permission to walk home by his/herself at the end of the Youth Group Program at Oak Park Church of Christ. I understand that Oak Park Church of Christ will not be liable for anything that happens to my child once he/she leaves the Youth Group Program.

Select One

Yes No

Checking Out

By selecting "yes" below, I, the above-named parent/guardian, hereby give my child, the above-named student, permission to check his/herself out at the end of the Youth Group Program at Oak Park Church of Christ. I understand that Oak Park Church of Christ will not be liable for anything that happens to my child once he/she leaves the Youth Group Program.

Select One

Yes No

Driving Home

By selecting "yes" below, I, the above-named parent/guardian, hereby give my child, the above-named student, permission to drive home by his/herself at the end of the Youth Group Program at Oak Park Church of Christ. I understand that Oak Park Church of Christ will not be liable for anything that happens to my child once he/she leaves the Youth Group Program.

Select One

Yes No

I, the above-named parent/guardian, hereby give permission for the following people to drive my child home at the end of the Youth Group Program at Oak Park Church of Christ. I understand that Oak Park Church of Christ will not be liable for anything that happens to my child once he/she leaves the Youth Group Program.

List People Here:

Parent/Guardian Options:

Oak Park Church of Christ is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities at Oak Park Church of Christ. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish Oak Park Church of Christ to limit the information collected, or to view your child's information, please contact us. I have read and understood and agree with the above and by clicking submit I agree to cover all Youth Ministry activities for the program year effective September 1, 2020, to August 31, 2021. A separate Informed Letter of Consent will be sent home for off-site activities and activities of elevated risk.

Date of Submission:

Youth Ministry Registration and Consent 2020/2021

Description

Please Fix the Following