Family, Youth and Children's Ministry Participant Information Form 2024-2025

CONTACT INFORMATION

Child/Youth Information

Child/Youth Name

Date of Birth

Child/Youth School (name)

Child/Youth Grade in Fall 2024

Child/Youth Email

Child/Youth Cell Phone

Child/Youth Address

Primary Adult Information

Parent or Grandparent: If you are the adult who regularly brings this child/youth to church, please complete this section.

Provide information about an additional parent/guardian in the "Additional Adult" section.

Parent/Grandparent Name

Parent/Grandparent Email

This address will receive a confirmation email

Parent/Grandparent Cell Phone

Parent/Grandparent Home Phone

Parent/Grandparent Address

Additional Adult Information

Provide information about additional adult (parent/guardian) here.

Parent/Guardian Name

Parent/Guardian Email

Parent/Guardian Cell Phone

Parent/Guardian Home Phone

Parent/Guardian Address

Alternate Emergency Contact Information

In the event of an emergency, every effort will be made to contact the persons named above. Please name an alternate contact in the event that primary contacts can not be reached:

Name

Relation to child/youth

Phone

MEDICAL/HEALTH INFORMATION

Please indicate any medical/health information that adults should be aware of or sensitive to when planning and and leading programming activities and events.

Allergies

Other Physical/Medical concerns

Behavioral/Mental Health concerns

Medications that may be carried/used during programming/events (e.g. Epi-Pen, inhaler)

LIABILITY RELEASE / CONSENT FOR TREATMENT

I hereby release Forest Hill Church, Presbyterian (FHC), its staff and volunteer leaders of all liability for any injury or illness that my child/youth may sustain during programming activities and events sponsored by the church.

In the event of an emergency, FHC staff and volunteer leaders will make every effort to contact me, or the alternate persons named, as soon as possible. I authorize FHC staff and volunteer leaders to seek medical treatment for my child/youth. I give my consent to examination, diagnosis, treatment and/or care of my child/youth by a certified provider in a physican's office, emergency room or hospital.

Permission granted:

Yes No

MEDIA RELEASE

Images and recordings help us tell the story of Forest Hill Church and communicate our commitment to becoming the beloved community. Media images enhance the quality of information we provide to members, visitors, and the community about our worship, programming and activities.

Please indicate your permission below for the image/photo/video of the child/youth named above to be used in church-related materials, including but not limited to, bulletins, posters, brochures, newsletters and other printed materials and on the church's website and social media platforms.

Permission granted:

Yes No

PLEASE TYPE YOUR FULL NAME BELOW AND SUBMIT TO SIGN.

You acknowledge that all information submitted on this form will apply to FHC sponsored programming activities and events during the 2024-25 program year (Sept 2024-Aug 2025.)

Please notify Amy Wheatley, ce@fhcpresb.org of any significant changes in contact information, medical information or health concerns.

Full Name of Person Completing this Form

Description

Please complete and submit one form for each child/youth in your family who will participate in FHC programming this year (Sept 2024-August 2025)

The information you provide will be treated confidentially and is used only for purposes of church-related communication and the health and safety of your child/youth when participating in church programming.

If you have questions or concerns, please contact Amy Wheatley, Director of Family, Youth and Children's Ministry, ce@fhcpresb.org. Thank you!

Family, Youth and Children's Ministry Participant Information Form 2024-2025

Description

Please Fix the Following