Childrens and Youth Ministry Registration & Consent 2020-2021

Information received is confidential and is being gathered for the purposes of serving your Child while in the care of King's Corner Church of God. Any medical information collected here serves to authorize King's Corner Church of God, and its staff and volunteers, to obtain medical assistance in emergencies.
Please note that the form will need to be completed for each child under the age of 18.
In the case of custody agreements, please include the proper form authorizing Parental contacts.
Parents Info

 
 
 
 
 
Childs Info

 
 
 
 
 
 
Please select one option.
Does your Child have any physical, emotional, mental, behavioural concerns or limitations that staff should be aware of?: (required)
 
 
 
 
Please select one option.
 
 
 
 
We may want to use photos/videos for church promotion. Please choose below to grant permission for the reasonable use of pictures containing your Child in any or all of the following ways: Please check all that apply:
Please select all that apply.

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 [the children’s Pastor, Mandy Ross, and or the Youth Pastor, Phil Simms] or one of King’s Corner Church of God 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 , King’s Corner Church of God, 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 King’s Corner Church of God, as well as of any medical treatment authorized by the supervising individuals representing King’s Corner Church of God. This consent and authorization is effective only when participating in or traveling to events sponsored by King’s Corner Church of God.

   In accordance with King's Corners Church's Protection Policy, regarding Youth ( a child aged 13-18)  I/We, the parents, or guardians of the above named child give authorization to the Youth Pastor, Phil Simms, to contact our child regarding Youth programming provided by King's Corner Church.  With the understanding that all email and text correspondance will be copied to us, and all conversations on social media will be done in plain sight.


     I/We, the parents, or guardians also give our authorization for any of the Pastoral team to counsel our child named above, within the guidlines of King's Corner Church's Protection policy. With the understanding that there is confidentiality between Pastor and youth within the confines of "normal" adolescent issues, beyond what is deemed "normal" parents will be notified of the conversation, and documentation will be submitted to the director or administrators of our Protection Policy.

Purposes and Extent
King’s Corner Church of God 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 King’s Corner Church of God . This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish King’s Corner Church of God to limit the information collected, or to view your Child’s information, please contact us.
Please select all that apply.
 
 

Description

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