BPC Children and Youth Ministry Registration 2022-2023

Children/Youth Information

Name

Address

Child / Youth email (if available)

Child / Youth cell phone (if available)

Date of Birth

Primary Care Physician Name

Physician Phone Number

List other authorized adults over 18, other than parents, who are permitted to pick up your child.

Additional Information (learning differences, allergies, medications, other pertinent health information)

Parents of third graders, please write the name of your child as you would like it to appear in their Bible:

Parents of 6th graders, please indicate your child's preference Participate with children's ministry activities only (Sunday school will continue to be during Sunday worship service and other events by arrangement) Participate in youth ministry activities only (typically will be 5:00-6:30 Sundays or by arrangement for special events)

If grade 6 and up, would your child like to be a helper during Sunday School? Yes No Not sure

For those community members participating in the BPC Christmas musical or other activities as a guest I am only participating in this specific activity, and will not be participating in other programming at BPC I would be interested in other programming at BPC, and would like to receive emails / mailers with updates on offerings

Parent/Guardian Information

Name - Parent 1

Address

This address will receive a confirmation email

Cell phone

Name - Parent 2

Address

Cell phone

Emergency/Alternate Contact Information (other than parent/guardian)

Primary Emergency Contact

Cell phone

Secondary Emergency Contact

Cell phone

First Aid and Emergency Medical Treatment

I give permission for my child/children to participate in BPC Church School and related events. In case of an emergency, I understand that every effort will be made to contact the parents/guardians or alternate emergency contacts of the registered child/children.

I hereby give permission for agents of BPC, attending physician(s) or other medical personnel to see and secure any needed medical attention or treatment for my child/children, and to administer any needed medical treatment, including hospitalization and surgery, if in the agent's option such a need arises.

I understand and agree that I am financially responsible and agree to pay all fees and costs arising from this action to obtain medial treatment, including transportation, for my child/children.

I hereby release Bedford Presbyterian Church, its employees, and volunteers from any responsibility for injuries or illness occurring as a result or coincidence to the participation of my child/children in these programs.

First Aid/Medical Treatment

Yes, I consent to the above. No, I do not consent to the above.

Photo and Video Release

I hereby grant persmission to Bedford Presbyterian Church (BPC) to use photographs/videos of my child/children involved in church sunday school and related activities, on the church website and social media platforms, including local television broadcasting, or in other official organization publications. I understand that the names and personal information of my child/children will be kept confidential and will not be posted with photos or videos.

Photo/Video Release

Yes, I consent to the above. No, I do not consent to the above.

BPC Children and Youth Ministry Registration 2022-2023

Description

Please Fix the Following