Parental Consent Form 2018/19

Parental Consent Form 2018/19

Souderton Mennonite Church Registration and Parental Consent Form
SMC Children's Ministry 2018-2019

If you have more than three children enrolled please contact Sarah Scorzetti for additional forms

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  • Name(s) of insured children

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  • ... to participate in all church-sponsored activities on the church premises, and trips and activities away from the church premises throughout the current school year. Children will be accompanied by a teacher or adult sponsor and will be under adequate supervision. I/we understand that I/we will be given prior notice of all trips away from the church premises. I/we further understand that I/we may revoke permission for a specific activity or trip at any time.

    Although the church desires to provide a safe and enjoyable time for all children and youth, accidents can still happen. I/we understand that there are risks/dangers involved with partcipation in on and off campus events and their associated activities. In consideration of my child being allowed to participate in church sponsored activities or trips, I/we agree to hold harmless Souderton Mennonite Church (SMC), its employees and representatives, including volunteers and drivers, from any and all claims arising from my child's participation. This release agreement does not apply to claims of intentional misconduct by the church, its employees or volunteers.

    In case of an accident, illness, or other emergency. I/we request that SMC contact me/us. If SMC cannont reach a parent/guardian after conscientious effort, I/we give permission for church staff to call paramedics or any licensed physician or dentist. If a life-threatening emergency exist. I/we give permission for the church staff to call paramedics immediately and then contact me/us as soon as possible thereafter.

    I/we authorize and consent to any X-ray examination, anesthetic, medical, dental, or surgical diagnosis or treatment and hospital care, which, in the best judgment of a licensed physician or dentist deemed advisable. I/we agree to assume the financial responsibility for expenses incurred as a result of those services being provided. I/we agree to be financially responsible for emergency mediacl transportation. In cases where medical care is needed but the situation is not an emergency, SMC will make every effort to contact parents/guardians BEFORE treatment is given.

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  • FOR CHILDREN PARTICIPATING IN OFF-CAMPUS AND OVERNIGHT TRIPS, PLEASE COMPLETE THE FOLLOWING QUESTIONS

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  • THIS FORM IS VALID FOR THE CURRENT SCHOOL YEAR, SEPTEMBER 1, 2018 THROUGH AUGUST 31, 2019. THIS FORM MUST BE UPDATED ON AN ANNUAL BASIS. IN ADDITION, IF THERE ARE ANY CHANGES IN YOUR CHILD'S MEDICAL CARE PROVISION OR NEEDS, PLEASE CONTACT THE CHILDREN'S MINISTRY DIRECTOR, IMMEDIATELY.

    If you have more than three children to enroll then please contact Sarah for additional forms

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