Sunday School Registration and Medical Consent form

For the School Year 2024/25
Information received is confidential and is being gathered for the purposes of serving your child while in the care of Timothy Eaton Memorial Church. Any medical information collected here serves to authorize Timothy Eaton Memorial Church, and its staff and volunteers, to obtain medical assistance in emergencies.

(This form have been adapted from Plan to Protect® A Safeguarding Guide for Children, Youth and Adults, permission granted by © Plan to Protect® 2022)

Your name *

Email address *

Child #1 Info

Child #1 - First and Last Name *

Child #1 - Date of Birth *

Child #1 - Health Card Number *

Child #1 - Medical Notes *

Please include allergies/dietary restrictions

Child #2 Info

Child #2 - First and Last Name

Child #2 - Date of Birth

Child #2 - Health Card Number

Child #2 - Medical Notes

Please include allergies/dietary restrictions

Child #3 Info

Child #3 - First and Last Name

Child #3 - Date of Birth

Child #3 - Health Card Number

Child #3 - Medical Notes

Please include allergies/dietary restrictions

Parent/Guardian Info

Parent/Guardian - First and Last Name

Phone number

Email Address

Parent/Guardian - First and Last Name

Phone number

Email Address

Does your child(ren) have any physical, emotional, mental, behavioural concerns or limitations that staff should be aware of? Please explain below.

If none, type "N/A"

Is your child(ren) bringing any medication with them? Please list below.

If none, type "N/A"

In case of emergency, please include info of contact below.

First and Last Name, Phone Number, Email, Relationship with child(ren)

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 Bonnie Marsh or one of the Ministry 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 Ministry Personnel, T.E.M.C., and its Leaders from and against any loss, damage or injury suffered by the participant because of being part of the activities of T.E.M.C., as well as of any medical treatment authorized by the supervising individuals representing T.E.M.C. This consent and authorization is effective only when participating in or traveling to events sponsored by T.E.M.C.

Communication

A policy is in effect that communication is to be used solely for the dissemination of information. Please sign below to grant permission for Children/Youth Program Ministry Personnel (staff and volunteers) to communicate with you and your child via telephone, email, social media, and text.

Photos

Please sign below to grant permission for the reasonable use of pictures containing your child in any or all of the following ways: Brochures/Promotional material, website, video, church newsletters, etc.

Purposes and Extent

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

Parent/Guardian Options *

I have read, understood, and agree with the all the above and sign it to cover all Children/Youth Program activities for the program year. A separate Letter of Informed Consent will be sent home for off-site activities and activities of elevated risk.

I understand and agree.

A copy of your responses will be sent to your email address.