Youth Release Form

This form is to be filled out by the parents/guardians of minors attending youth ministry programs at Southwest Community Church (SWCC). The information is being gathered for the purpose of serving and protecting your child while in the care of SWCC.

Student's Information

Student's Full Name:

Student's Email:

Address:

Student's Mobile Phone Number:

Home Phone Number:

Student's Birthday Date:

Student's Gender:

Student's Grade:

Student Allergies:

We want to support your child the best that we can. Does your child have any physical, emotional, behavioral concerns or limitations that our team should be aware of? If yes, please explain:

Parent/Guardian Information

(1) Parent/Guardian Full Name:

(1) Parent/Guardian Phone Number:

(1) Parent/Guardian Email:

This address will receive a confirmation email

(2) Parent/Guardian Full Name:

(2) Parent/Guardian Phone Number:

(2) Parent/Guardian Email:

This address will receive a confirmation email

Guidelines for Small Group Leader & Mentor Face-to-Face Meetings

Do you the parent/guardian grant permission for your son/daughter's small group leader to meet with them face-to-face for the entire school year. This permission will be secured in writing and maintained in church office.

Even with said documentation, face to face meetings will only occur under the following conditions:

*The parent must confirm that they are aware of the time, location, and travel arrangements of each meeting. This confirmation is to be made in writting to the Ministry Personnel (with a copy sent to the Ministry Leader).

*The Ministry Leader is to keep all such communications on file.

*Meetings are to take place in a public place or in a home where family is present.

*Any exceptions to any of the above guidelines must be approved by the Ministry Leader and the parents, and written documentation of this approval must be provided and kept on record.

Please check one of the boxes indicating you have read and agree/disagree to the above statement.

I/we agree I/we do not agree

Name of Parent(s)/Guardian(s) Giving Consent (This constitutes your electronic signature):

Guidelines for Non Face-to-Face Communication

Non face-to-face communication by way of text messaging and other social media platforms is encouraged for the purpose of communication of information and for friendly banter. Social networking is not to be used when communication moves beyond transfer of information and moves to deeper areas of meaningful relationship or counselling type content.

Do you the parents/guardians grant permission for your son/daughter's small group leader to contact them outside of ministry programming via text messaging, email and other social network messaging and chat. This permission is secured on this form and will be maintained online and in the church office.

When contacting students via text messaging, email and other social networking or chat, small group leaders are to:

*Not text or phone students after 10pm or before 8am.

*Keep communication in public forums (in case it needs to be reviewed)

*If communication does move beyond a transfer of information or friendly banter, records of such communication should be kept by obtaining copies and sending them to the ministry leader.

*Video chats are discouraged unless both parties are in a public setting or public part of the home.

Please check one of the boxes indicating you have read and agree/disagree to the above statement.

I/we agree I/we do not agree

Name of Parent(s)/Guardian(s) Giving Consent (This constitutes your electronic signature):

Medical Treatment Authorization

I/we the parents or guardians named authorize SWCC youth ministry team to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant who is named on this form.
I/we, named on this form, undertake and agree to indemnify and
hold blameless the pastoral team, ministry staff, SWCC youth ministry
leadership team (both volunteer and paid), SWCC, the SWCC Leadership team, and the SWCC 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 SWCC, as well as of any medical treatment authorized by the supervising individuals
representing either SWCC.

Please check one of the boxes indicating you have read and agree/disagree to the above statement.

I/we agree I/we do not agree

Name of Parent(s)/Guardian(s) Giving Consent (This constitutes your electronic signature):

Photo/Video Authorization

I/we, the undersigned, give permission to SWCC, and/or parties designated by SWCC to photograph/video me and use such photograph(s)/video(s) in all forms of media, for any and all promotional purposes including advertising, display, audiovisual, exhibition or editorial use.

Please check one of the boxes indicating you have read and agree/disagree to the above statement.

I/we agree I/we do not agree

Name of Parent(s)/Guardian(s) Giving Consent (This constitutes your electronic signature):

Youth Release Form

Description

Please Fix the Following