Baptism Parent/Guardian Consent Form
Please complete this form to provide consent for your child’s baptism and to share important contact and emergency information with Walker Academy.
Student Information
Please provide the information for the student who is being considered for baptism.
Student Full Name
*
First Name
Last Name
Student Date of Birth
*
-
Month
-
Day
Year
Date
School Name
*
Current Grade
*
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Other
Parent/Guardian Information
Enter the contact information for the parent or legal guardian completing this form.
Parent/Guardian Full Name
*
First Name
Last Name
Relationship to Student
*
Mother
Father
Legal Guardian
Other
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Parent/Guardian Email Address
*
example@example.com
Consent Acknowledgements
Please read each statement carefully and enter your initials in the box to indicate your understanding and agreement.
I understand the meaning and significance of baptism as it is taught by Walker Academy and our faith community.
*
I affirm that my child has expressed a desire to be baptized and has participated in any required preparation or instruction.
*
I consent to my child’s participation in the baptism service and any related activities organized by Walker Academy.
*
I understand that reasonable care will be taken for my child’s safety, and I release Walker Academy and its staff from liability except in cases of gross negligence or willful misconduct.
*
Photo and Video Permission
This section is optional and relates to the use of your child’s image in school-related media.
Do you give Walker Academy permission to photograph or video your child during baptism-related activities and to use these images in school communications and promotional materials?
*
Yes, I give permission.
No, I do not give permission.
Emergency Contact Information
Provide an emergency contact who can be reached during the baptism service or related activities (other than the primary parent/guardian, if possible).
Emergency Contact Full Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Emergency Contact Relationship to Student
Parent/Guardian Authorization and Signature
By signing below, you confirm that you are the parent or legal guardian of the student named above and that you provide consent for their baptism as indicated on this form.
Parent/Guardian Printed Name
*
Parent/Guardian Signature
*
Date Signed
*
-
Month
-
Day
Year
Date
Walker Academy Use Only
The following fields are to be completed by Walker Academy staff only.
Baptism Date
-
Month
-
Day
Year
Date
Facilitator/Leader
Internal Notes
Submit Consent Form
Submit Consent Form
Should be Empty: