Youth

JUNIOR & SENIOR YOUTH GROUP

Grade 6-12 Youth Small Group Bible Study

TIME: 6-8:30PM

FRIDAY’S: See Calendar below for dates

Leaders – Mark Cacka, Hanna Ankrom, Cadence Harper, Phil Shpakowsky, Katherine Kuefler, Lisa Harper

**snacks, games, bible study, group discussion**

Youth Group: Registration and Consent Form

Information received is confidential and is being gathered for the purposes of serving your Child while in the care of Entwistle Community Church. Any medical information collected here serves to authorize Entwistle Community Church, and its staff and volunteers, to obtain medical assistance in emergencies. This form should be completed annually by a nguardian with the child in their care

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Child’s name *

Childs Date of Birth *

Address

Phone Number (Primary) *

Guardians Work Number

Health Card Number

Family Doctor

Doctor Number

Allergies (if any)

In case of an emergency contact: *

Number *

Does your Child have any physical, emotional, mental, behavioral concerns or limitations that staff should be aware of? *YesNo

If yes, please explain:

Is your Child bringing any medication with him/her?* *YesNo

If yes, to medication please explain:

Other details

The safety of your Child is our primary concern. Precautions will be taken for their well-being and protection. nI/we, the Guardians listed below, authorize the Youth Coordinator, or one of Entwistle Community Churchesn Youth/Children Personnel to sign a consent form for nmedical treatment and authorize any physician or hospital to provide medical assessment, ntreatment, or procedures for the participant named above. n I/we, the Guardians listed below, also undertake and agree to indemnify and hold nharmless Ministry Personnel, Entwistle Community Church, and it’s leaders against any nloss, damage, or injury suffered by the participant as a result of being part of Entwistle nCommunity Church , as well as of any medical treatment authorized by the supervising nindividuals representing Entwistle Community Church. The consent and authorization is neffective only when participating in or travelling to events sponsored by Entwistle nCommunity Church. n I/we, the Guardians listed below, consent to our child attending the program nCornerstone Kids at Entwistle Community Church. Knowing it may entail: devotional times, nsnack time, game time (indoor and outdoor on the Entwistle Community Church property), ncraft time, music, and interaction with other kids who attend. n n

Communication: n A policy is in effect that communication is to be used solely for the dissemination of ninformation. Please sign below to grant permission for Ministry Personnel (staff and nvolunteers) to communicate with your Child via monitored telephone, email, social media, nand text (check all that apply):

CommunicationTelephoneEmailSocial Media NetworksText Messages

Photos: nPlease sign below to grant permission for the reasonable use of pictures containing your Child nin any or all the following ways (Your child’s name will not be used):

PhotosBrochures-Promotional MaterialWebsiteVideotapingChurchNewslettersYear End Fun Video

Purposes and Extent: n Entwistle Community Church is collecting and retaining this information for the purpose of enrolling your child inton our program, to assign the student to the appropriate classes, to develop and nurture ongoing relationshipsn with you or your child, and to inform you of program updates and upcoming opportunities at our organization. nThe information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel.n If you with Entwistle Community Church to limit the information collected, or to view your child’s information,n please contact us.

Parent/ Guardian Options: n I have read, understood, and agree with all listed above and sign it to cover all the Children’s activities for the program:n Cornerstone kids; year effective listed below. nA separate informed letter of consent will be issued for offsite activities and activities of elevated risk.

Your Name *

Email *

Witness Name *

Date *

Ministry Lead Name:

Permission form is effective: March 04, 2025 – July 01, 2025