Permission Form for V&M Children's Ministry

Parent / Caretaker / Guardian Details

Name

This address will receive a confirmation email

Phone

Address

Additional Name(s)

Additional Email

This address will receive a confirmation email

Additional Phone

Other (non-primary) person and/or number to call in emergency:

Are you interested in volunteering with V&M children's ministry?

Yes, please send me more details. No, not at this time!

Participant(s) Details

Name(s) & Pronouns

Age(s) & Birth Month/Day

Email(s)

2022 Virtual Youth Ministry Events

Please see the RSVP form linked here: https://vm.breezechms.com/form/e167154484

Online Ministry Details

Please download the Zoom Details for Parents and Caretakers document here.

Please select the following to indicate you have read the Zoom Details for Parents and Caretakers and understand the use of Zoom within V&M Children's Ministry.

Yes, I read this document and understand it's contents.

Online Acceptable Use Agreement (Updated: Jan 2021)

Please download the Acceptable Use Agreement here.

Please select the following to indicate you have read the Online Acceptable Use Agreement and understand these agreements for technology use within V&M Children's Ministry.

Yes, I read this document and understand it's contents.

In-Person Ministry Details

Is your child presently being treated for an injury or sickness or taking any medication? (details encouraged)

What are your child's personal physical, emotional, and spiritual accessibility needs? (i.e. sensitive to light/sound, mobility devices, portable oxygen, multi-faith, etc)

Medical Treatment Authorization

My permission is granted for the Church, Pastor, Minister of Music, Youth, and other staff personnel or other adult(s) in charge to obtain necessary medical attention from a provider or medical institution in case of sickness or injury to my child. I, the undersigned, do verify that the information shared is correct.

Name(s) & Contact Details:

Immunizations:

Allergies and/or Allergic Reactions (food, insect stings/bites, medication):

Any Current Medication:

Additional Information:

Parent / Caretaker / Guardian Permissions

Please indicate your consent for each using the form below, check only one (YES/NO):

I am the parent or legal guardian of the child named above, and I do consent to the participation of my child in the programs & activities conducted by V&M:

Yes No

I confirm that my child is aware and informed that I have given permission for them to attend V&M programs and events.

Yes No

I understand the safety guidelines and understand that we ALL cocreate community safety:

Yes, we will stay in communication about these. No, I need more information about this.

I give permission for still / video images which may include my child to be shared in community through digital media and publications.

Yes, please reach out for each photo/video to confirm consent. No, never share any media. I would like to learn more about this.

I have read and understood the information in the letter and given my consent that my child take part in the Valley and Mountain Children’s Ministry.

Yes No

Please share any additional comments, questions, hesitations, celebrations, or concerns regarding participation in V&M Children’s Ministry here:

Permission Form for V&M Children's Ministry

Description

Please Fix the Following