Parental Consent Form

Parental Consent Form

Grace Presbytery Children and Youth Events
Child Name*

First NameLast Name
Child's Information
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone*

Area CodePhone Number
Emergency Contact Name(if parent or guardian is not avaliable)

First NameLast Name
Emergency Number*

Area CodePhone Number
Emergency Number #2

Area CodePhone Number
Birth Date*

MonthDayYear
Gender
Parent or Legal Guardian Information
Parent/Legal Guardian

First NameLast Name
Relation*
Cell Phone*

Area CodePhone Number
Parent /Legal Guardian 2

First NameLast Name
Relation 2
Cell Phone 2

Area CodePhone Number
Email Confirmation
Parent's Email
example@example.com
Church Leader's Email
example@example.com
Health Information
If nothing applies, please put "NONE" in the box.
Any activity the child should be restricted from?
Any physical, mental or other condition (including ADHD, autism, or sensory issues) that would be helpful for ministry staff to know while your child is attending an event?
List any allergies (ex: bees,peanuts, dairy)
Any dietary needs that we should know about?
List all medications, both prescribed and over the counter. All medications will be turned into adult leaders except rescue inhalers. Bring all medication in original containers.
Photos and videos will be taken during this event and may be used for publicity, including on social media, for Grace Presbytery youth ministries. Grace Presbytery makes every effort to protect the privacy and dignity of your children. We will not include biographical information with your child's picture/likeness. Additionally, you or your child may request media containing your child's image to be removed at any time. Check below to indicate your consent for the use of your child's image.

I consent to the use of photos and videos of my child.I do not consent to the use of photos and videos of my child.
By signing and submitting this form, you agree that you are the parent or legal guardian of the above-named camper, and are acknowledging that the above named child will be participating in this event and its related activities and using facilities of the hosting institution at the participant's own risk. You also consent to release, discharge, and indemnify Grace Presbytery of Irving, Texas and its directors, officers, employees, agents, and volunteers as well as the hosting institution/camp from all liabilities for damage, injury, or illness to the above named participant or their property during their participation in or travel to and from this Grace Presbytery youth event. In case of a medical emergency or general medical care, I give consent for medical treatment for the above-named camper by authorized personnel. I certify that my child has my permission to attend Grace Presbytery youth events and participate in all activities.
Signature*
Should be Empty:

Parental Consent Form

Child's Information

Parent or Legal Guardian Information

Email Confirmation

Health Information