Youth Medical & Consent Form • Bracken Ridge Baptist Church

CHILD'S DETAILS

First Name *

Last Name *

Preferred Name

Gender

Date of Birth *

Email Address

Mobile Number

Address Line 1

Suburb

Postcode

School

School Grade

PERMISSIONS AND MEDICAL DETAILS

Do you consent for your child's photo to be taken? May be used for website, social media, advertising, etc. *

Do you consent for your child to travel to offsite events on a bus and/or in a leader's car? *

Does your child have any medical conditions, special needs or allergies? Please list.

Is there any other information we need to know to care for your child? example - custody orders

Interaction Permission (email, facebook, instagram, text, phone calls)

Our goal in all our ministries is to play a significant role in the social, emotional and spiritual development of those who attend. This requires more interaction between attendees and our leaders/mentors than can occur in the few hours at a church service or youth activity. Modern communication tools and online social media platforms provides many powerful tools to allow that interaction to happen. However, we are very aware that and some may hesitate to allow their children to engage with others using these tools. We train all our leaders in using communication technology and social media appropriately and each leader must sign our Code of Conduct to be a leader.

By agreeing to the following you are giving permission for Youth Groups Leaders to be;

- "friends" on Facebook and communicate via the platform.

- "followed" by your child and for leaders to "follow" them back on instagram and tiktok and communicate via the platform.

- in contact using text and or phone calls.

- in contact using emails

Do you give permission for Leaders to contact your child using the technology/platforms listed above? *

Yes

BEHAVIOIUR AGREEMENT

Bracko Youth is committed to keeping all youth safe and maintaining the wellbeing and best interests of youth who engage with the ministry. The House Rules and Code of Conduct aims to ensure that everyone who participates in Backo Youth or any other related event understand what is expected of them and feels safe, respected, valued and treated equally.

Bracko Youth expects all who take part in any related event to display appropriate behaviour at all times.

View the House Rules and Participant Code of Conduct here.

Acknowledgement

I have read and understand Bracko Youth's code of conduct and house rules. I agree to abide by the house rules and code of conduct, and any other rules that are communicated in any way by any leader or staff member at all times. *

I agree

I understand that Bracko Youth has the right to take action at the discretion of Bracko Youth if we breach the code of conduct or house rules. *

I agree

I understand that I may be removed as a participant if I breach the code of conduct or any house rules *

I agree

PARENT/CARER DETAILS

We are required to have details for 2 parents/carers or trusted contacts who can make decisions in an emergency. These people need to be contactable during youth programs. The first contact will also be sent information about future programs via email.

First Parent/Carer or Emergency Contact

Name *

Contact Number *

Second Parent/Carer or Emergency Contact

Name *

Contact Number *

I declare that the information provided above is true and correct. In consideration of the facilities provided by you for our child, I hereby absolutely release and discharge the Bracken Ridge Baptist Church and its employees, agents and volunteers from and against all claims whatsoever arising out of death, personal injury, or loss of or damage to personal property that we or the child may suffer or sustain in the course of their involvement in programs at Bracken Ridge Baptist Church and we hereby indemnify and agree to keep indemnified the Bracken Ridge Baptist Church and its employees, agents and volunteers against all claims whatsoever by us or the child or by any person claiming through us or through the child on our behalf or on the behalf of the child in any way arising, and this discharge may be pleased in bar to any such claim.

Provided that the above does not apply to any claim or any claim to the extent that the Bracken Ridge Baptist Church is indemnified by a policy of insurance issued by a solvent insurer and we further agree that in the event of injury to our child, you are authorized by us to obtain at our expense any medical, ambulance or like services which you in your absolute discretion think necessary or desirable.

Do you agree? *

Yes