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Ignite Activities Consent Form (2024-2025 School Year)

This consent form grants permission for 6th-12th grade students to participate in activities with Ignite Student Ministry at Tidal Creek Fellowship (Beaufort, SC), including transportation to events, and provides necessary medical release and treatment information for emergency situations. Please ensure all sections are completed for your child's safety and well-being.

If you have multiple students in middle/high school, you can specify multiple participants and fill out the necessary info for all of your teens/pre-teens on one form. Please contact josh@tidalcreek.net if you have any questions.

By checking the boxes and signing below, you acknowledge that you have read and consent to the following statements: 


CONSENT AND CERTIFICATION

I, the undersigned, being the parent or legal guardian of the youth named above, do hereby consent to the participation of my child in all the scheduled youth activities of IGNITE Student Ministry/Tidal Creek Fellowship, and any other supervised activities customarily associated with its youth group, including youth events and overnight or weekend youth trips. Further, I certify that my child is physically fit and adequately prepared to participate in all recreational and sporting events. If I wish to revoke this consent for any reason, I will promptly notify the student pastor in writing.

I Agree


MEDICAL TREATMENT AUTHORIZATION

I understand that I will be notified in the case of a medical emergency. However, in the event that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event that my child is injured or becomes ill. I authorize one or more of the following persons to make emergency medical care decisions on behalf of my child, if required by law or a health care provider: adults designated by the Student Pastor as volunteers and Josh Dorrity (Student Pastor). I authorize these persons to act in my place to consent to all necessary and appropriate x-ray examinations, anesthetic, medical or surgical diagnosis or treatment, and hospital care. 

I understand that Tidal Creek Fellowship/IGNITE Student Ministry will not be responsible for medical expenses incurred solely on the basis of this authorization. I further agree to notify the Student Pastor in writing of any health changes that would restrict my youth’s participation in any normal youth activities. I also understand that the Student Pastor and designated adult chaperones reserve the right to restrict my child from any activity that they do not feel is within the physical capabilities of my child.

I Agree


EVENT/TRANSPORTATION PERMISSION

I hereby, grant permission for my child to participate in an activity/event away from the Church site. I also understand that this activity/event may require transportation to a location away from the Church site and grant permission for my child to ride in a vehicle approved by the Student Pastor (Josh Dorrity) and with an adult driver approved by the Student Pastor. This activity/event will take place under the guidance and direction of the Student Pastor/IGNITE Student Ministry Volunteers/Chaperones of Tidal Creek Fellowship.  

As parent/legal guardian, I remain legally responsible for any personal actions taken by the named student ("participant"). I agree on behalf, my child named herein, or our heirs, successors, and assign, to harmless and defend (Tidal Creek Fellowship), its leaders, volunteers, Pastor and chaperones or representatives associated with the event with respect to any and all actions, claims or demands that may be made or brought against Tidal Creek Fellowship, arising from or in connection with my child's attending the event or in connection with any illness or injury or cost of medical treatment in connection there within.  

I do release and hereby agree to hold harmless Tidal Creek Fellowship from any and every claim arising, or which may be asserted by me or by any member of my family by reason of participating in any activities associated with events. I also release the lessor of properties on which the event is being held (either on Church grounds or away).

I Agree


STUDENT PLEDGE

I, the undersigned parent or legal guardian of the participant(s) on this form, hereby acknowledge that my child is expected to uphold all policies of Ignite Student Ministry of Tidal Creek Fellowship during all youth activities and trips, and I acknowledge that I have reviewed and understand the following statement: 

"Each participant listed on this form pledges to uphold all policies of Ignite Student Ministry of Tidal Creek Fellowship. During all youth activities and trips, the participant(s) is/are required to follow all instructions of the Student Pastor and adult chaperones, including any safety-related guidelines."

I Agree


December 21, 2024

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
Is your child presently being treated for an injury or sickness or taking any medication?*
No
Yes

If Yes, please explain.
Does your child have, or has your child ever had, any of the following? (Please check all that apply) *
Asthma
Diabetes
Hay Fever
Heart Condition
Kidney Disease
Seizure Disorders
NONE OF THESE

If you checked any of these options, please explain.

Does your child have any allergies? (If so, please list them here. If not, please just type "No.") *
Does your child ever sleepwalk?*
No
Yes

Child's blood type (if known)
Does your child have a physical handicap or illness that would prevent him or her from participating in normal rigorous activity?*
No
Yes

If yes, please explain.

Family Doctor (Type N/A if you don't have one) *

Doctor's Phone Number (Type N/A if you don't have one) *

Insurance Company (Type N/A if you don't have one) *

Insurance Policy Number (Type N/A if you don't have one) *
Photo & Video Consent: We value your child's privacy and are committed to protecting it. We occasionally take photos and videos of participants in our student ministry programs to share the positive impact of our ministry and/or promote upcoming activities. These images may be used for promotional purposes, including, but not limited to, social media, websites, newsletters, and other church-related publications. We will not use your child’s full name, identifying information, or personal details without explicit additional consent. If you would like to opt out of photo and video use, please select "No." By selecting "Yes" below, you acknowledge and agree to give permission for Tidal Creek Fellowship to use photos and videos of your child in the above-described manner.*
Yes
No
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Is your child presently being treated for an injury or sickness or taking any medication?*
No
Yes

If Yes, please explain.
Does your child have, or has your child ever had, any of the following? (Please check all that apply) *
Asthma
Diabetes
Hay Fever
Heart Condition
Kidney Disease
Seizure Disorders
NONE OF THESE

If you checked any of these options, please explain.

Does your child have any allergies? (If so, please list them here. If not, please just type "No.") *
Does your child ever sleepwalk?*
No
Yes

Child's blood type (if known)
Does your child have a physical handicap or illness that would prevent him or her from participating in normal rigorous activity?*
No
Yes

If yes, please explain.

Family Doctor (Type N/A if you don't have one) *

Doctor's Phone Number (Type N/A if you don't have one) *

Insurance Company (Type N/A if you don't have one) *

Insurance Policy Number (Type N/A if you don't have one) *
Photo & Video Consent: We value your child's privacy and are committed to protecting it. We occasionally take photos and videos of participants in our student ministry programs to share the positive impact of our ministry and/or promote upcoming activities. These images may be used for promotional purposes, including, but not limited to, social media, websites, newsletters, and other church-related publications. We will not use your child’s full name, identifying information, or personal details without explicit additional consent. If you would like to opt out of photo and video use, please select "No." By selecting "Yes" below, you acknowledge and agree to give permission for Tidal Creek Fellowship to use photos and videos of your child in the above-described manner.*
Yes
No
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Is your child presently being treated for an injury or sickness or taking any medication?*
No
Yes

If Yes, please explain.
Does your child have, or has your child ever had, any of the following? (Please check all that apply) *
Asthma
Diabetes
Hay Fever
Heart Condition
Kidney Disease
Seizure Disorders
NONE OF THESE

If you checked any of these options, please explain.

Does your child have any allergies? (If so, please list them here. If not, please just type "No.") *
Does your child ever sleepwalk?*
No
Yes

Child's blood type (if known)
Does your child have a physical handicap or illness that would prevent him or her from participating in normal rigorous activity?*
No
Yes

If yes, please explain.

Family Doctor (Type N/A if you don't have one) *

Doctor's Phone Number (Type N/A if you don't have one) *

Insurance Company (Type N/A if you don't have one) *

Insurance Policy Number (Type N/A if you don't have one) *
Photo & Video Consent: We value your child's privacy and are committed to protecting it. We occasionally take photos and videos of participants in our student ministry programs to share the positive impact of our ministry and/or promote upcoming activities. These images may be used for promotional purposes, including, but not limited to, social media, websites, newsletters, and other church-related publications. We will not use your child’s full name, identifying information, or personal details without explicit additional consent. If you would like to opt out of photo and video use, please select "No." By selecting "Yes" below, you acknowledge and agree to give permission for Tidal Creek Fellowship to use photos and videos of your child in the above-described manner.*
Yes
No
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Is your child presently being treated for an injury or sickness or taking any medication?*
No
Yes

If Yes, please explain.
Does your child have, or has your child ever had, any of the following? (Please check all that apply) *
Asthma
Diabetes
Hay Fever
Heart Condition
Kidney Disease
Seizure Disorders
NONE OF THESE

If you checked any of these options, please explain.

Does your child have any allergies? (If so, please list them here. If not, please just type "No.") *
Does your child ever sleepwalk?*
No
Yes

Child's blood type (if known)
Does your child have a physical handicap or illness that would prevent him or her from participating in normal rigorous activity?*
No
Yes

If yes, please explain.

Family Doctor (Type N/A if you don't have one) *

Doctor's Phone Number (Type N/A if you don't have one) *

Insurance Company (Type N/A if you don't have one) *

Insurance Policy Number (Type N/A if you don't have one) *
Photo & Video Consent: We value your child's privacy and are committed to protecting it. We occasionally take photos and videos of participants in our student ministry programs to share the positive impact of our ministry and/or promote upcoming activities. These images may be used for promotional purposes, including, but not limited to, social media, websites, newsletters, and other church-related publications. We will not use your child’s full name, identifying information, or personal details without explicit additional consent. If you would like to opt out of photo and video use, please select "No." By selecting "Yes" below, you acknowledge and agree to give permission for Tidal Creek Fellowship to use photos and videos of your child in the above-described manner.*
Yes
No
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Is your child presently being treated for an injury or sickness or taking any medication?*
No
Yes

If Yes, please explain.
Does your child have, or has your child ever had, any of the following? (Please check all that apply) *
Asthma
Diabetes
Hay Fever
Heart Condition
Kidney Disease
Seizure Disorders
NONE OF THESE

If you checked any of these options, please explain.

Does your child have any allergies? (If so, please list them here. If not, please just type "No.") *
Does your child ever sleepwalk?*
No
Yes

Child's blood type (if known)
Does your child have a physical handicap or illness that would prevent him or her from participating in normal rigorous activity?*
No
Yes

If yes, please explain.

Family Doctor (Type N/A if you don't have one) *

Doctor's Phone Number (Type N/A if you don't have one) *

Insurance Company (Type N/A if you don't have one) *

Insurance Policy Number (Type N/A if you don't have one) *
Photo & Video Consent: We value your child's privacy and are committed to protecting it. We occasionally take photos and videos of participants in our student ministry programs to share the positive impact of our ministry and/or promote upcoming activities. These images may be used for promotional purposes, including, but not limited to, social media, websites, newsletters, and other church-related publications. We will not use your child’s full name, identifying information, or personal details without explicit additional consent. If you would like to opt out of photo and video use, please select "No." By selecting "Yes" below, you acknowledge and agree to give permission for Tidal Creek Fellowship to use photos and videos of your child in the above-described manner.*
Yes
No
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Is your child presently being treated for an injury or sickness or taking any medication?*
No
Yes

If Yes, please explain.
Does your child have, or has your child ever had, any of the following? (Please check all that apply) *
Asthma
Diabetes
Hay Fever
Heart Condition
Kidney Disease
Seizure Disorders
NONE OF THESE

If you checked any of these options, please explain.

Does your child have any allergies? (If so, please list them here. If not, please just type "No.") *
Does your child ever sleepwalk?*
No
Yes

Child's blood type (if known)
Does your child have a physical handicap or illness that would prevent him or her from participating in normal rigorous activity?*
No
Yes

If yes, please explain.

Family Doctor (Type N/A if you don't have one) *

Doctor's Phone Number (Type N/A if you don't have one) *

Insurance Company (Type N/A if you don't have one) *

Insurance Policy Number (Type N/A if you don't have one) *
Photo & Video Consent: We value your child's privacy and are committed to protecting it. We occasionally take photos and videos of participants in our student ministry programs to share the positive impact of our ministry and/or promote upcoming activities. These images may be used for promotional purposes, including, but not limited to, social media, websites, newsletters, and other church-related publications. We will not use your child’s full name, identifying information, or personal details without explicit additional consent. If you would like to opt out of photo and video use, please select "No." By selecting "Yes" below, you acknowledge and agree to give permission for Tidal Creek Fellowship to use photos and videos of your child in the above-described manner.*
Yes
No
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Is your child presently being treated for an injury or sickness or taking any medication?*
No
Yes

If Yes, please explain.
Does your child have, or has your child ever had, any of the following? (Please check all that apply) *
Asthma
Diabetes
Hay Fever
Heart Condition
Kidney Disease
Seizure Disorders
NONE OF THESE

If you checked any of these options, please explain.

Does your child have any allergies? (If so, please list them here. If not, please just type "No.") *
Does your child ever sleepwalk?*
No
Yes

Child's blood type (if known)
Does your child have a physical handicap or illness that would prevent him or her from participating in normal rigorous activity?*
No
Yes

If yes, please explain.

Family Doctor (Type N/A if you don't have one) *

Doctor's Phone Number (Type N/A if you don't have one) *

Insurance Company (Type N/A if you don't have one) *

Insurance Policy Number (Type N/A if you don't have one) *
Photo & Video Consent: We value your child's privacy and are committed to protecting it. We occasionally take photos and videos of participants in our student ministry programs to share the positive impact of our ministry and/or promote upcoming activities. These images may be used for promotional purposes, including, but not limited to, social media, websites, newsletters, and other church-related publications. We will not use your child’s full name, identifying information, or personal details without explicit additional consent. If you would like to opt out of photo and video use, please select "No." By selecting "Yes" below, you acknowledge and agree to give permission for Tidal Creek Fellowship to use photos and videos of your child in the above-described manner.*
Yes
No
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Is your child presently being treated for an injury or sickness or taking any medication?*
No
Yes

If Yes, please explain.
Does your child have, or has your child ever had, any of the following? (Please check all that apply) *
Asthma
Diabetes
Hay Fever
Heart Condition
Kidney Disease
Seizure Disorders
NONE OF THESE

If you checked any of these options, please explain.

Does your child have any allergies? (If so, please list them here. If not, please just type "No.") *
Does your child ever sleepwalk?*
No
Yes

Child's blood type (if known)
Does your child have a physical handicap or illness that would prevent him or her from participating in normal rigorous activity?*
No
Yes

If yes, please explain.

Family Doctor (Type N/A if you don't have one) *

Doctor's Phone Number (Type N/A if you don't have one) *

Insurance Company (Type N/A if you don't have one) *

Insurance Policy Number (Type N/A if you don't have one) *
Photo & Video Consent: We value your child's privacy and are committed to protecting it. We occasionally take photos and videos of participants in our student ministry programs to share the positive impact of our ministry and/or promote upcoming activities. These images may be used for promotional purposes, including, but not limited to, social media, websites, newsletters, and other church-related publications. We will not use your child’s full name, identifying information, or personal details without explicit additional consent. If you would like to opt out of photo and video use, please select "No." By selecting "Yes" below, you acknowledge and agree to give permission for Tidal Creek Fellowship to use photos and videos of your child in the above-described manner.*
Yes
No
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Is your child presently being treated for an injury or sickness or taking any medication?*
No
Yes

If Yes, please explain.
Does your child have, or has your child ever had, any of the following? (Please check all that apply) *
Asthma
Diabetes
Hay Fever
Heart Condition
Kidney Disease
Seizure Disorders
NONE OF THESE

If you checked any of these options, please explain.

Does your child have any allergies? (If so, please list them here. If not, please just type "No.") *
Does your child ever sleepwalk?*
No
Yes

Child's blood type (if known)
Does your child have a physical handicap or illness that would prevent him or her from participating in normal rigorous activity?*
No
Yes

If yes, please explain.

Family Doctor (Type N/A if you don't have one) *

Doctor's Phone Number (Type N/A if you don't have one) *

Insurance Company (Type N/A if you don't have one) *

Insurance Policy Number (Type N/A if you don't have one) *
Photo & Video Consent: We value your child's privacy and are committed to protecting it. We occasionally take photos and videos of participants in our student ministry programs to share the positive impact of our ministry and/or promote upcoming activities. These images may be used for promotional purposes, including, but not limited to, social media, websites, newsletters, and other church-related publications. We will not use your child’s full name, identifying information, or personal details without explicit additional consent. If you would like to opt out of photo and video use, please select "No." By selecting "Yes" below, you acknowledge and agree to give permission for Tidal Creek Fellowship to use photos and videos of your child in the above-described manner.*
Yes
No
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Is your child presently being treated for an injury or sickness or taking any medication?*
No
Yes

If Yes, please explain.
Does your child have, or has your child ever had, any of the following? (Please check all that apply) *
Asthma
Diabetes
Hay Fever
Heart Condition
Kidney Disease
Seizure Disorders
NONE OF THESE

If you checked any of these options, please explain.

Does your child have any allergies? (If so, please list them here. If not, please just type "No.") *
Does your child ever sleepwalk?*
No
Yes

Child's blood type (if known)
Does your child have a physical handicap or illness that would prevent him or her from participating in normal rigorous activity?*
No
Yes

If yes, please explain.

Family Doctor (Type N/A if you don't have one) *

Doctor's Phone Number (Type N/A if you don't have one) *

Insurance Company (Type N/A if you don't have one) *

Insurance Policy Number (Type N/A if you don't have one) *
Photo & Video Consent: We value your child's privacy and are committed to protecting it. We occasionally take photos and videos of participants in our student ministry programs to share the positive impact of our ministry and/or promote upcoming activities. These images may be used for promotional purposes, including, but not limited to, social media, websites, newsletters, and other church-related publications. We will not use your child’s full name, identifying information, or personal details without explicit additional consent. If you would like to opt out of photo and video use, please select "No." By selecting "Yes" below, you acknowledge and agree to give permission for Tidal Creek Fellowship to use photos and videos of your child in the above-described manner.*
Yes
No
Parent or Guardian's Email Address

Email*
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

Emergency Contact's Relation to Participant
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*

Middle Name

Last Name*

Relationship*

Phone*
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 Date of Birth*
Parent or Guardian's Information
Is your child presently being treated for an injury or sickness or taking any medication?*
No
Yes

If Yes, please explain.
Does your child have, or has your child ever had, any of the following? (Please check all that apply) *
Asthma
Diabetes
Hay Fever
Heart Condition
Kidney Disease
Seizure Disorders
NONE OF THESE

If you checked any of these options, please explain.

Does your child have any allergies? (If so, please list them here. If not, please just type "No.") *
Does your child ever sleepwalk?*
No
Yes

Child's blood type (if known)
Does your child have a physical handicap or illness that would prevent him or her from participating in normal rigorous activity?*
No
Yes

If yes, please explain.

Family Doctor (Type N/A if you don't have one) *

Doctor's Phone Number (Type N/A if you don't have one) *

Insurance Company (Type N/A if you don't have one) *

Insurance Policy Number (Type N/A if you don't have one) *
Photo & Video Consent: We value your child's privacy and are committed to protecting it. We occasionally take photos and videos of participants in our student ministry programs to share the positive impact of our ministry and/or promote upcoming activities. These images may be used for promotional purposes, including, but not limited to, social media, websites, newsletters, and other church-related publications. We will not use your child’s full name, identifying information, or personal details without explicit additional consent. If you would like to opt out of photo and video use, please select "No." By selecting "Yes" below, you acknowledge and agree to give permission for Tidal Creek Fellowship to use photos and videos of your child in the above-described manner.*
Yes
No
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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