Sr. High Consent Form

senior high consent form

This is an Online Authorization & Medical Consent Form that will cover your teen for all Sr. High Youth Ministry activities (Youth Group, Events, etc) at Emmanuel Baptist Church.

This form covers your teen from Sept. 1st, 2022 to August 31st, 2023.
Adding your (the parent/guardian) full name and today's date to the bottom of this form will be considered your signature of consent, acknowledging that you have read, understood, and agree with the statement below:

I/we, the parents or guardians named above, authorize Pastor Mitch Hogeveen or one of the Emmanuel Baptist Church ministry leaders to sign a 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 above, undertake and agree to indemnify and hold blameless Pastor Mitch Hogeveen, the ministry leaders, Emmanuel Baptist Church, its Pastors and Board Members from and against any loss, damage, or injury suffered by the participant as a result of being apart of the activities of Emmanuel Baptist Church as well as of any medical treatment authorized by the supervising individuals representing the church. This consent and authorization is effective only when participating in or traveling to events of Emmanuel Baptist Church. I understand that not all youth events are held at the church. I give my child permission to participate in events that take place away from the church, understanding that they will be traveling by bus, rental van, or personal vehicles driven by adult volunteers. I/we understand that photos or videos may be taken of my child during a youth event and may be used in promotional materials both print and web. I/we give permission to be contacted by email about Youth Ministry related events and information.

IMPORTANT

When filling out the form:

"First Name" and "Last Name" refer to the name of the teen you are registering.
There is a space further down in the form for parents name.

*Denotes Required Field * Title

* First Name

* Last Name

* Address 1

Address 2

* City

State/Prov

* Zip/Postal Code

* Birthdate

* Grade

* School

* Parent(s) or Guardian(s) Names

* Parents Primary Email

* Primary Phone Number

* Please indicate if the phone # is a "home phone," "mom's cell," or "dad's cell"

* Please provide the Name of an Emergency Contact Person (other than yourself)

* What is the emergency contact's relationship to the teen? (ex. dad, grandma, neighbour, etc)

* Emergency Contacts Phone Number

* Does your child have any health problems, allergies, or medications? Yes or No? If yes, pls explain

* Does your child have an behavioural or emotional concerns? Yes or No? If yes, please explain

* Please add your (parent/guardian) full name and today's date below as your signature of consent.