Family Ministry Permission Form

Family Ministry Registration and Consent Form

Information received is confidential and is being gathered for the purposes of serving your Child while in the care of Bethel Church. Any medical information collected here serves to authorize Bethel Church, and its staff and volunteers, to obtain medical assistance in emergencies.

In the case of custody agreements, please include the proper form authorizing Parental contacts.

Child's Name

First NameLast Name

Current Grade

Date of Birth

Date

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

BC Services Card Number

ParentGuardians Name

Parent/Guardian's Phone (H)

Format: (000) 000-0000.

Family Doctor

Doctor's Phone Number

Format: (000) 000-0000.

Allergies

In case of an emergency contact

Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Does your Child have any physical, emotional, mental, behavioural concerns or limitations that staff should be aware of?

If yes please explain

Is your Child bringing any medication with him/her?

If yes please list

Bethel Church Plan to Protect Policy

The safety of your Child is our primary concern. Precautions will be taken for their well-being and protection.

I/we, the Parents or guardians named below, authorize one of Bethel Church Program 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 below, undertake and agree to indemnify and hold harmless Program Personnel, Bethel Church, and its Leaders from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Bethel Church, as well as of any medical treatment authorized by the supervising individuals representing Bethel Church. This consent and authorization is effective only when participating in or travelling to events sponsored by Organization.

Please choose grant permission for the reasonable use of pictures containing your Child in any or all of the following ways:

If your child is 13 years old or older: A policy is in effect that communication is to be used solely for the dissemination of information. Please sign below to grant permission for Youth Ministry Personnel (staff and volunteers) to communicate with your Child via telephone, email, social media and text:

Purposes and Extent:

Bethel 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 organization. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish Bethel Church to limit the information collected, or to view your Child’s information, please contact us.

By typing my name below, I acknowledge and agree that this typed name constitutes my electronic signature and has the same legal effect as a handwritten signature. I understand and intend that this electronic signature is valid and binding under applicable Canadian laws, including the Personal Information Protection and Electronic Documents Act (PIPEDA) and any relevant provincial electronic commerce legislation.

This form will be valid until August 31, 2026.

(Esignature) Printed Name

Date