Childrens' / Student Ministry Registration and Parental Consent Form

Information received on this form is confidential and is being gathered for the purposes of serving your child while in the care of Hillside Free Methodist Church. Hillside Free Methodist Church is collecting and retaining this personal information for the purpose of enrolling your child in our programs, 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 Church. This information will be maintained indefinitely as it is a requirement of our insurance company. If you wish Hillside Free Methodist Church to limit the information collected, or if you would like to view your child’s information, please contact us.

Contact Information

Child's Name:

Date of Birth:

School and Grade:

Parent/Guardian Name(s):

Mailing Address

Parent/Guardian Email Address(es):

This address will receive a confirmation email

I prefer to be contacted via:

phone call text email

Please attach a photo of your child.

Upload (8MB)

(Alternatively, you can email your child's photo to hillsidefmc@gmail.com)

For office use: picture received?

Yes No

Medical Information

Child's Health Card Number:

Family Doctor/Clinic:

Emergency Contact Name:

Emergency Contact Relationship to Child:

Emergency Contact Phone Number:

Allergies:

Does your child have any physical, emotional, and/or behavioural concerns or limitations that our staff should be aware of?

Yes No

If yes, please explain:

Is your child bringing any medication(s) with him/her?

Yes No

If yes, please name each medication and explain its use:

The safety of your child is our primary concern. Precautions will be taken for their wellbeing and protection.

I/we, the parents or guardians named above, authorize the Pastor of Hillside Free Methodist Church or one of its Ministry Personnel 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 Hillside Free Methodist Church, its Ministry Personnel, Pastor, Staff and Board from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of the Hillside Free Methodist 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 the childrens’ or student ministries of the Hillside Free Methodist Church.

Photos/Video

Photo and Video Permissions:

I grant permission for the reasonable use of pictures/video containing my child in any or all of the following ways: brochures/promotional material, church use, website, newsletters I DO NOT grant permission for identifiable pictures of my child to be used in any way

Note: Please contact the church office if you would like a picture of your child removed from any publication

Consent

Confirmation of Consent:

I have read, understood, and agree to the above, and consent to my child’s participation in the Childrens’/Student Ministry of Hillside Free Methodist Church for the school year:

September 20____ to August 20____

Parent/Guardian Name (Please Print):

Parent/Guardian Signature:

Date:

Childrens' / Student Ministry Registration and Parental Consent Form

Description

Please Fix the Following