Authorization and Medical Consent, Media Release Form, 2025/26

Your name *

Email address *

My child participates at Bethel in: *

(please check all that apply)
For Awana registration please visit: https://bethelbiblechapel.twotimtwo.com/

Jr. Youth Group (grade 6-8)

Sunday School

Youth Group (Grade 9-12)

Students' Name *

Address *

Phone number *

Birthdate *

Gender *

Grade *

Parent's / Caregiver's Name(s) *

Parent's Cell Phone Number(s)

Please add as many numbers as would be helpful in case of an emergency

Medical Information

This information is collected for use should an emergency situation arise during Bethel's programing.

Allergies

Does your child have any food or environmental allergies that we should know about?

Medical Concerns

Does your child have any medical considerations or conditions our team should be aware of?

Health Card Number: *

Name of Family Doctor: *

Doctor's Phone Number *

Does your child have any physical, emotional, mental, or behavioural concerns or limitations that our team should be aware of? *

Yes

Is your child bringing any medication with him/her? *

Yes

Emergency Contacts

In case of an emergency or concern our team will contact the people below in the order listed.

If parents or primary caregiver cannot be reached please contact: *

please provide name, relationship, and phone number

Consent, Permission, and Release form

The safety of your child is our primary concern. Precautions will be taken for their well-being and protection.

Participation Consent *

I give permission for my child to participate in scheduled activities, which will be held at Bethel Bible Chapel and at other locations during the year. (Note: Notices will be sent home in advance of such activities)

Medical Treatment Consent *

I/we, the parents or caregivers named above, authorize one of the Bethel Bible Chapel Ministry Staff to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above.

Liability Release *

I/we, named above, undertake and agree to indemnify and hold blameless the Ministry Staff, Bethel Bible Chapel, and its 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 Bethel Bible Chapel, as well as of any medical treatment authorized by the supervising individuals representing the church. This consent and authorization is effective only when participating in or travelling to events of Bethel Bible Chapel.

Media Release

At times our ministry staff may take photos or videos containing your child for reasonable use in brochures or promotional material, in newsletters or annual reports or on Bethel’s website.
I give permission to Bethel Bible Chapel to use any image or likeness of my child for promotional purposes. Student Ministry Activities

Use of Private Data Acknowledgement *

Bethel Bible Chapel is collecting and retaining this personal information for the purpose of enrolling your child in our programs, assigning the student to the appropriate classes, developing and nurturing ongoing relationships with you and your child, and informing you of program updates and upcoming opportunities at Bethel. This information will be maintained indefinitely. If you wish Bethel Bible Chapel to limit the data collected, or to view your child’s information, please contact us.