Children 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 Glen Glem Church. Any medical information collected here serves to authorize Glen Elm Church and its staff and volunteers, to obtain medical assistance in emergencies.
Please note that this 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
 
 
 
 
 
 
Does your Child have any physical, emotional, mental, behavioral concerns or limitations that staff should be aware of?:
 
Please select all that apply.
 
Please select all that apply.
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 note names will never be used alongside photos!
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, Bonnie Maw or the Youth Pastor, Jonathan Slywka, or one of Glen Elm Church's 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, Glen Elm Church of Christ, 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 Glen Elm Church of Christ, as well as of any medical treatment authorized by the supervising individuals representing Glen Elm Church of Christ. This consent and authorization are effective only when participating in or traveling to events sponsored by Glen Elm Church of Christ.

In accordance with Glen Elm Church of Christ Protection Policy Training, any communication should be available to parents at any time and should not be done in secret without the parent's knowledge. 


I/We, the parents or guardians also give our authorization for any of the Pastoral team to have a conversation within the guidelines of Glen Elm Church's Child Protection Policy Training, with the understanding that there is confidentiality between Pastor and child/youth within the confines of "normal" child or 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
Glen Elm Church of Christ 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 Glen Elm Church of Christ. This information will be maintained likely indefinitely as it is a requirement of our insurance company and legal counsel. If you wish Glen Elm Church of Christ 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 Glen Glem Church. Any medical information collected here serves to authorize Glen Elm Church and its staff and volunteers, to obtain medical assistance in emergencies.