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We are planning an online ministry opportunity as part of our programming that requires your permission prior to participation.  We have provided you the details of the activity and request that you complete and sign the permission form.  The safety of your child is our primary concern.  Precautions will be taken for their wellbeing and protection

Activity: Junior High Wed Night Service

Schedule of Activity: Wednesday of every week from 7-8pm until we are permitted to meet in person

Details of the Activity: Junior High Wednesday Nights will be held over Zoom through the Kennedy Road Jr High account, with the addition of one more screened ministry personnel. Log on at home and  have some fun chatting, worshipping and growing together. In order to be permitted into the online youth ministry the name on the account you are using must match your child’s name on the consent form. No one will be permitted to join without signed consent.

I hereby consent to the participation of my child in this online youth ministry.

I authorize my child to use their webcam during the online youth ministry.

I Agree

I/we, named below, undertake and agree to indemnify and hold blameless Kennedy Road Tabernacle, its personnel, its volunteers, its Directors and Board from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Kennedy Road Tabernacle, as well as of any medical treatment authorized by the supervising individuals representing Kennedy Road Tabernacle.  This consent and authorization is effective only when participating in Kennedy Road Tabernacle online youth ministry.

I/we understand that for the purpose of security, each session will be recorded and stored on the secure server of Kennedy Road Tabernacle and accessed only by the ministry leader, and their supervisor. Recordings will not be shared or posted online. I/we will communicate to my child(ren) that no screen shot/photos are to be taken or posted.

I Agree

Purposes and Extent

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

First Student(s) Name

First Name*

Last Name*

Phone*
First Student(s) Date of Birth*
First Student(s) Signature*
Second Student(s) Name

First Name*

Last Name*
Second Student(s) Date of Birth*
Third Student(s) Name

First Name*

Last Name*
Third Student(s) Date of Birth*
Fourth Student(s) Name

First Name*

Last Name*
Fourth Student(s) Date of Birth*
Fifth Student(s) Name

First Name*

Last Name*
Fifth Student(s) Date of Birth*
Sixth Student(s) Name

First Name*

Last Name*
Sixth Student(s) Date of Birth*
Seventh Student(s) Name

First Name*

Last Name*
Seventh Student(s) Date of Birth*
Eighth Student(s) Name

First Name*

Last Name*
Eighth Student(s) Date of Birth*
Ninth Student(s) Name

First Name*

Last Name*
Ninth Student(s) Date of Birth*
Tenth Student(s) Name

First Name*

Last Name*
Tenth Student(s) Date of Birth*
Student(s) Address
Address Line 1:
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:
City:
State/Province:
Zip/Postal:
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
Parent or legal guardian must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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