Devon Community Church: Authorization and Medical Consent Form

Information recieved is confidential and is being gathered for the purpose of serving your youth while in the care of Devon Community Church. Any medical information collected here serves to authorize Devon Community Church, and its staff and volunteers, to obtain medical assistance in emergencies.

 

Purpose and Extent: Devon Community Church is collecting and retaining this personal information for the purpose of enrolling your youth in our programs, to assign the sutdent to the appropriate classes, to develop and nurture ongoing relationships with you and your youth, and to inform you of programs and upcoming opportunities at our church. This information with be maintained indefinitely as it is a requirement of our insurance company and legal council. If you wish Devon Community Church to limit the information collected, or to view your child's information, please contact us.

1a. Youth #1 Information

1b. Youth #2 Information

1c. Youth #3 Information

2. Parent(s)/Guardian(s) Information

3. Picture/Video/Social Media Information

4. Release Statement

By submitting this form, you, the parent or guardian named below, authorize the ministry staff of Devon Community Church to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessments, treatments or procedures for the youth named above. You undertake and agree to indemnify and hold blameless the ministry staff and volunteers, Devon Community Church, its pastors and Pastor's council from and against any loss, damage or injury suffered by the child as a result of being part of the programs of Devon Community Church as well as of any medical treatment authorized by the supervising individuals representing the church. 
You have read, understood, and agree with the above and sign it to cover your youth's participation in all Youth Ministries activities through Devon Community Church for the period of September 1, 2020 - August 31, 2021, effective when the form is submitted.