First Congregational UCC Children/Youth 2021-2022 Information and Consent Form

First Congregational UCC Children/Youth 2022-23 Information and Consent Form

You will complete a separate page for each child. You can skip past the duplicate pages if/when needed.
Child one
Child's name *

First Name Last Name
Child's pronouns *
Child's phone number ONLY IF in middle/high school
Please enter a valid phone number.
Age *
Date of Birth *

Month Day Year
Date
School *
Grade Level *
Does your child have any allergies or other medical conditions? *

Child's name

First Name Last Name
Child two (if applicable)
Child's pronouns
Child's phone number ONLY IF in middle/high school
Please enter a valid phone number.
Age
Date of Birth

Month Day Year
Date
School
Grade Level
Does your child have any allergies or other medical conditions?

Child three (if applicable)
Child's name

First Name Last Name
Child's pronouns
Child's phone number ONLY IF in middle/high school
Please enter a valid phone number.
Age
Date of Birth

Month Day Year
Date
School
Grade Level
Does your child have any allergies or other medical conditions?

Child four (if applicable)
Child's name

First Name Last Name
Child's pronouns
Child's phone number ONLY IF in middle/high school
Please enter a valid phone number.
Age
Date of Birth

Month Day Year
Date
School
Grade Level
Does your child have any allergies or other medical conditions?

Parent/Guardian Information

If you do not wish for a parent to be included in communication due to them not attending FCUCC, please do not include their information below.
Adult 1 Name *

First Name Last Name
Adult 1 Relationship *
Adult 1 Email *
example@example.com
Adult 1 Phone Number *
Please enter a valid phone number.
Adult 2 Name

First Name Last Name
Adult 2 Relationship
Adult 2 Email
example@example.com
Adult 2 Phone Number
Please enter a valid phone number.

Media Consent and General Acknowledgement
I give consent to First Congregational UCC to use pictures/videos of my child(ren) for church advertisements in all capacities and on all social media platforms, including www.uccmanhattan.org.

Please check ONE box.
If you chose "do not give consent" on the previous question, please answer the following question.

I give consent to First Congregational UCC to use pictures/videos of my child(ren) in the private Facebook group named "First Congregational UCC Members and Friends" ONLY.

Please check ONE box.
For middle/high school youth only

I give permission for First Congregational staff or adult leaders to contact my youth through text/phone in order to communicate about youth ministry programming and connect them to other youth who are a part of our ministries, as well as to check in with youth periodically to see how they are doing.

Please check ONE box.
Policies for Communication between Youth and Adults
Please read over these and share them with your youth. Clear expectations are our friend, so please let us know if you have any questions.

1) We will work to avoid one-on-one communication via text/online messages between a youth and an adult. Communication will primarily happen via group message, which will have at least two adults and other youth on them.

2) If an adult needs to communicate with a youth individually, that adult will copy another adult (parent or other church staff/leader) on the text.

3) If a youth initiates a messaging conversation with an adult that is one-to-one, the adult will copy another adult in (parent or other church staff/leaders) when they respond. If a youth and/or parent would prefer a specific adult not be included, the youth and/or parent/guardian will notify the youth director and/or pastor.

4) If a youth desires to have a one-on-one phone/video call with an adult, the adult will share with their supervisor that the conversation is taking place (youth staff/volunteers are supervised by the Pastor, Pastor is supervised by the Cabinet)
Parent/Guardian Signature *

Clear
Date Signed *

Month Day Year
Date
Parent/Guardian Signature

Clear
Date Signed

Month Day Year
Date

All volunteers and staff go through twice yearly training on emergency procedures including severe weather, fire, and active shooter. It is the policy of the church that there always be at least one volunteer or staff member present who is trained in First Aid and CPR. We also train all volunteers and staff on Safe Conduct procedures to ensure all children and youth are protected. Should you ever want to know more about these procedures or training, please don't hesitate to reach out to Brandy or Pastor Caela.
Check box to acknowledge understanding of Safe Conduct and Emergency procedures in place.
Should be Empty:

First Congregational UCC Children/Youth 2022-23 Information and Consent Form

Child one

Child two (if applicable)

Child three (if applicable)

Child four (if applicable)

Parent/Guardian Information

Media Consent and General Acknowledgement