Appendix 5: PARENTAL CONSENT

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

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For the School Year *
Required
Grade of Student *
Student Name *
Date of Birth *
MM
/
DD
/
YYYY
Mailing Address *
AB Health Card Number *
Family Doctor *
Family Doctor Phone Number *
Allergies *

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

 *
If yes to behavioural concerns, please explain
Is your child bringing any medication with him/her? 
 *
If bringing medication, please list
In Case of Emergency Contact *

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

Parents'/Guardian Names & Contact Numbers

 *

The safety of your child is our primary concern. Precautions will be taken for their wellbeing and protection.

Parent Name (typed signature) *
Date Signed *
MM
/
DD
/
YYYY

I/we, the parents or guardians named above, authorize Pastor Josh Bateman or one of the Elk Point Baptist Church Ministry Staff 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 above, undertake, and agree to indemnify and hold blameless Pastor , the Ministry Staff, Elk Point Baptist 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 the Elk Point Baptist 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 or traveling to events of the Elk Point Baptist Church.
 *

Photos

Please sign below to grant permission for the reasonable use of pictures containing your child in any or all of the following ways:

 *
Required
Option 1: I have read, understood, and agree with the above and sign it to cover all Student Ministry activities for the program year effective as stated below.
 *
Option 2:  I have read, understood, and agree with the above and sign it to cover only the activity listed below.
Parent Name (typed signature) *
Date Signed *
MM
/
DD
/
YYYY
Effective from date signed through to June 30, 2024 *

Purposes and Extent

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

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