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Greenville, S.C. 29605

Phone:

864-277-4617

website: myreedyfork.com

Youth / Children’s Ministry Activities Permission Form

(2024)

I, (parent/guardian), hereby give permission for my child to attend and participate in all supervised activities, events, field trips, retreats, camps, and service projects associated with the Youth/Children’s Ministry of Reedy Fork Baptist Church. I understand that reasonable plans have been made to ensure the safety and welfare of all participants. I also understand that volunteer adults and staff will be chaperoning Youth/Children’s Ministry activities and will take reasonable actions as they deem necessary to protect the best interests of all participants. This form will remain in effect from January 1, 2024 to December 31, 2024, while my child is a participant in the Youth/Children's ministry of Reedy Fork Baptist Church.  

In signing this document, my child also agrees to conduct himself/herself in a safe and orderly manner and will cooperate/comply with all decisions made by the adults and staff chaperoning.

Transportation Release

I further give permission for my child to be transported to and from events by hired and volunteer drivers that are over 21yrs of age & authorized by Reedy Fork Baptist Church.

Should it be necessary for our (my) child to return home due to medical reasons, disciplinary action, or otherwise, the undersigned shall assume all transportation costs.

Photo Release

I, give my permission to Reedy Fork Baptist Church and its staff to photograph and record my child and to use his/her image and sound in promotional materials (including brochures, flyers, website, social media, etc.) for Reedy Fork Baptist Church.

Medical Release Form

In the event of an emergency and I am unable to respond, I authorize the Youth/Children’s Ministry leaders or staff of Reedy Fork Baptist Church, hospitals, licensed medical or dental providers and their agents and employees, to have access to the information contained in this form and to provide all medical/dental treatment and necessary transportation advisable for the health and safety of my child. This authorization includes the authority to consent to any x-ray examinations, anesthetic, medical procedure or treatment, and hospital care, under the supervision and upon the advice of a licensed physician, surgeon, or dentist, for my child. I understand I am responsible for total payment of all treatment given.

Today's Date: April 19, 2024





First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Medical Information


Medication taken by student on regular basis:

Student’s known allergies (including food related):

Student’s known medical conditions/diseases:

Does student have any history of asthma, seizures, hyperactivity, attention deficit disorder, frequent headaches, or stomach aches? If so, please explain:

Is there any other special medical-related information we should know?
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Medical Information


Medication taken by student on regular basis:

Student’s known allergies (including food related):

Student’s known medical conditions/diseases:

Does student have any history of asthma, seizures, hyperactivity, attention deficit disorder, frequent headaches, or stomach aches? If so, please explain:

Is there any other special medical-related information we should know?
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Medical Information


Medication taken by student on regular basis:

Student’s known allergies (including food related):

Student’s known medical conditions/diseases:

Does student have any history of asthma, seizures, hyperactivity, attention deficit disorder, frequent headaches, or stomach aches? If so, please explain:

Is there any other special medical-related information we should know?
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Medical Information


Medication taken by student on regular basis:

Student’s known allergies (including food related):

Student’s known medical conditions/diseases:

Does student have any history of asthma, seizures, hyperactivity, attention deficit disorder, frequent headaches, or stomach aches? If so, please explain:

Is there any other special medical-related information we should know?
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Medical Information


Medication taken by student on regular basis:

Student’s known allergies (including food related):

Student’s known medical conditions/diseases:

Does student have any history of asthma, seizures, hyperactivity, attention deficit disorder, frequent headaches, or stomach aches? If so, please explain:

Is there any other special medical-related information we should know?
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Medical Information


Medication taken by student on regular basis:

Student’s known allergies (including food related):

Student’s known medical conditions/diseases:

Does student have any history of asthma, seizures, hyperactivity, attention deficit disorder, frequent headaches, or stomach aches? If so, please explain:

Is there any other special medical-related information we should know?
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Medical Information


Medication taken by student on regular basis:

Student’s known allergies (including food related):

Student’s known medical conditions/diseases:

Does student have any history of asthma, seizures, hyperactivity, attention deficit disorder, frequent headaches, or stomach aches? If so, please explain:

Is there any other special medical-related information we should know?
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Medical Information


Medication taken by student on regular basis:

Student’s known allergies (including food related):

Student’s known medical conditions/diseases:

Does student have any history of asthma, seizures, hyperactivity, attention deficit disorder, frequent headaches, or stomach aches? If so, please explain:

Is there any other special medical-related information we should know?
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Medical Information


Medication taken by student on regular basis:

Student’s known allergies (including food related):

Student’s known medical conditions/diseases:

Does student have any history of asthma, seizures, hyperactivity, attention deficit disorder, frequent headaches, or stomach aches? If so, please explain:

Is there any other special medical-related information we should know?
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Medical Information


Medication taken by student on regular basis:

Student’s known allergies (including food related):

Student’s known medical conditions/diseases:

Does student have any history of asthma, seizures, hyperactivity, attention deficit disorder, frequent headaches, or stomach aches? If so, please explain:

Is there any other special medical-related information we should know?
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Participant'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(s) or Court-Appointed Legal Guardian(s) 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.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also 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 Information

Medical Information


Medication taken by student on regular basis:

Student’s known allergies (including food related):

Student’s known medical conditions/diseases:

Does student have any history of asthma, seizures, hyperactivity, attention deficit disorder, frequent headaches, or stomach aches? If so, please explain:

Is there any other special medical-related information we should know?
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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