Information received is confidential and is being gathered for the purposes of serving your child while in the care of Port Perry Baptist Church. Any medical information collected here serves to authorize Port Perry Baptist Church, and its staff and volunteers, to obtain medical assistance in emergencies.
In the case of custody agreements, please include the proper form authorizing parental contacts.
Note: If your child has an epi-pen, a photo of your child needs to be submitted to the church office.
Signature of Consent:
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 above, authorize the Port Perry Baptist Church Ministry Personnel to sign 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 above, undertake and agree to indemnify and hold blameless the Ministry Personnel, Port Perry Baptist Church, its Pastors and Board of Elders from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of the Port Perry Baptist Church, as well as of any medical treatment authorized by the supervising individuals representing the church. This consent and authorization is effective only when participating in or traveling to events of the Port Perry Baptist Church.
I have read, understood and agree with the above and sign it to cover all ministry activities. Note: Ministry activities include but are not limited to:
- gym games
- jumping castle
- costume nights
Date: November 14, 2019