Calvary Youth Parent Consent - Long Form

Youth Information

Name

Address

Birthdate

Grade

Mobile

Youth Mobile Updates Opt In - As a youth you will receive periodic text updates including email alerts and bad weather program updates.

Yes No

Youth Medical Information

Does the youth you are registering have any allergies, dietary concerns, medical conditions or disabilities that we need to be aware of?

Yes No

If you marked yes above, please explain:

Health Card Number

Family Doctor's Name

Family Doctor's Phone Number

Parent/Guardian Information

Parent/Guardian Name

Second Parent/Guardian Name

Parent/Guardian Email

This address will receive a confirmation email

Parent/Guardian Primary Contact Number

Parent/Guardian Secondary Secondary Contact Number

Parent/Guardian Mobile Updates Opt In - You will receive periodic text updates including email alerts and bad weather program updates.

Yes No

Additional Information - Is there anything else we should be aware of that will help us care for your youth in the best way possible?

Emergency Contact Information

Emergency Contact Name

Emergency Contact - Relationship To Youth

Emergency Contact Phone Number

Consent & Parental Agreement

Please read the following conditions carefully, and contact us at angela@calvarygravenhurst.com if you have any questions.

Medical Care Release - The safety of your child is our primary concern. Precautions will be taken for their well-being and protection. I agree to any emergency treatment to be given as considered necessary. I undertake and agree to indemnify and hold harmless Calvary Gravenhurst 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 Calvary Gravenhurst, as well as of any medical treatment authorized by the supervising individuals representing Calvary Gravenhurst.

Yes

Media Release - I agree to photographs and short videos of activities including my youth to be taken for use within the church community and for possible public publication.

Yes No

Digital Signature

I have read, understood and agree with all of the above and sign this consent form to cover all Calvary Youth Program activities for June 2023 - September 2024. I understand that if any information on this form changes, it is my responsibility as a parent/guardian to make the organizers aware in writing so that changes can be made to Calvary Gravenhurst's database.

I understand that if I wish to withdraw my consent at anytime, I must do so in writing to Calvary Baptist Church (Calvary Gravenhurst) and give adequate time for processing.

Digital Signature of Parent/Guardian

Date of Signature of Parent/Guardian

Description

Please fill out this form for each individual who will be attending Calvary Youth. Please ensure you click submit when you are finished entering all of the necessary information.

Calvary Youth Parent Consent - Long Form

Description

Please Fix the Following