FLC Children's Sunday Programs Visitor Form
Please fill out the following information prior to your child's first time attending. This provides us with the details we need to properly care for your child and to reach you as their parent/guardian if needed.
Name of Child
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First Name
Last Name
Name your child responds to?
Date of Birth
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Month
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Day
Year
Date
Gender
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Female
Male
Medical Conditions/Allergies
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Is your child bringing any medication with him/her?
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Yes
No
If yes, please list:
Which Children's Sunday Program will your child be visiting?
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9:15am Sunday School (Preschool-Kindergarten)
9:15am Sunday School (Grade 1-2)
9:15am Sunday School (Grade 3-4)
9:15am Sunday School (Grade 5-6)
11am Nursery (born 2023 or later)
11am Sunday Worship (Preschool-Kindergarten)
11am Kidz Church (Grade 1-2)
11am Kidz Church (Grade 3-4)
11am Kidz Church (Grade 5-6)
When will you be visiting?
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Month
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Day
Year
Date
Name of Parent(s)/Guardian(s):
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Relationship to Child
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Father
Mother
Guardian
Cell Phone for Emergency Contact
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Please enter a valid phone number.
Release & Permission Statements
**CONSENT TO MEDICAL TREATMENT** I/we, the parents or guardians named above, authorize one of the Fraser Lands Church Ministry Staff or Volunteers 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.
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I Agree
**LIABILITY RELEASE** I/we, named above undertake and agree to indemnify and hold blameless the Ministry Staff and Volunteers of Fraser Lands Church, its' Pastors and Board of Elders from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Fraser Lands 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 events of Fraser Lands Church.
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I Agree
**MEDIA RELEASE** I/we, named above, authorize Fraser Lands Church to use any photographs or video taken of my child while participating in childrens programs of Fraser Lands Church. I/we understand that photographs or video of my child may be used in newsletters, printed promotional materials, bulletin boards, annual reports, on the Fraser Lands Church website, and on official Fraser Lands Church social media and consent to such use. Note: photos or video where a person is not identifiable may be used without consent. It is my responsibility as parent or guardian to instruct my child to avoid official ministry cameras if it is my preference that photos and videos of my child be used.
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I Agree
I understand and acknowledge that when my child participates in the children's programs listed above, they are under supervision only during the applicable time periods stated above. I HAVE READ, UNDERSTOOD AND AGREE WITH ALL THE ABOVE AND SIGN IT TO COVER ALL FRASER LANDS CHURCH CHILDREN'S MINISTRY ACTIVITIES FOR THE CURRENT PROGRAM YEAR.
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I Agree
FRASER LANDS CHURCH CONSENT AND RELEASE FORM FOR CHURCH-SPONSORED VIRTUAL EVENTS AND MINISTRY
AUTHORIZATION, CONSENT AND RELEASE FOR USAGE OF SOCIAL MEDIA AND/OR OTHER ELECTRONIC COMMUNICATION INVOLVING MINORS
1. I, (The parent/guardian named above) acknowledge that I am the parent/guardian of the child(ren) named above and legally represent my child(ren). 2. I understand that I will have access to everything provided to my child(ren) and be made aware of how social media is being used, be told how to access the sites or applications, and be given the opportunity to be copied on all material sent to my child(ren) via social networking (including text messages). 3. I authorize and consent to the staff and ministry personnel of the Fraser Lands Church to communicate with my child(ren) electronically, including via social media, text, email, phone and video conferencing tools in accordance with the program(s). 4. I understand that if any staff or ministry personnel knowingly communicate privately with my child(ren) as a part of his or her duties for or on behalf of Fraser Lands Church, reasonable steps will be taken to send to me the same communication content, though not necessarily via the same technology. I acknowledge that to review or receive public communications shared via social media with my child(ren), I will need to become a user of the same social media. 5. I understand that communications or posts may be accessible or viewable by others who are also users of the same social media. I understand that without this consent my child(ren) will not be able to participate in the program(s). If I choose to rescind my authorization and consent provided herein, I agree that I will inform Fraser Lands Church in writing and that my rescission will not take effect until it is acknowledged by Fraser Lands Church. 6. I understand, however, that it may not be possible to recall any work, photos or videos that have been published as part of the program(s) prior to receipt of my written rescission. I have read this Consent and Release Form and have had the opportunity to consider its terms and understand them. 7.I verify that I have read and voluntarily agree to the terms and conditions of the Consent and Release Form. I further hereby hold harmless, release and forever discharge Fraser Lands Church and its staff, ministry personnel, and legal representatives from, and shall indemnify them against, all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators or any other person(s) acting on my behalf or on behalf of my estate have or may have by reason of my child(ren)’s participation in the program(s) and through my authorization, consent and release herein. 8. I have read this Consent and Release Form, I fully understand it, and I voluntarily agree to be bound by its terms.
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I Agree
Today's Date (NOTE: this form is ONLY valid for the Sunday your child will be visiting our Sunday programs during the selected hours)
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Month
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Day
Year
Date
Signature
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Submit
Should be Empty: