2025/2026 Grace Kids Senior Annual Consent Form

Once you have completed this form, you do not have to fill in another Annual Consent Form for the rest of the school year. This form covers August 2025 to July 2026.

Information received is confidential and is being gathered for the purposes of serving your child while in the care of Grace Community Church. Any medical information collected here serves to authorize Grace Community Church, and its staff and volunteers, to obtain medical assistance in emergencies. In the case of custody agreements, please speak to the Co-Directors of Children's Ministries, Charlene Nurmi and Annica Napier, to ensure the proper authorizing parental contacts information is recorded. If you have any questions or concerns, please contact our Kids Co-Directors, Charlene and Annica, at charlene@gracecommunity.ca and annica@gracecommunity.ca.

Your name *

Email address *

Student's Name *

Birthdate

School

Grade

Address

Photo, Social Media, & Information Release

Photos and videos from Grace Youth events may be used on a variety of mediums, including social media, print photos, and our website. *

Social media is an important part of connecting with teens through cultivating an online presence. As such, we will often create and post social media content from videos and photos taken at Youth. To get an idea of what this may look like, you can visit our Instagram account @graceyouthguelph or @gracekidsguelph. Please read the photo and video usage options below and select which one you would like to apply to your child.
UNRESTRICTED USAGE: I give permission for my child’s image to be used in print, video, and digital media. I agree that these images may be used by Grace Community Church for a variety of purposes and that these images may be used without further notifying me. I do understand that the child’s name will not be used in conjunction with any video or digital images.
LIMITED USAGE: I give permission for my child’s image to be used within the Grace Community Church setting ONLY, such as wall photos or a photo directory.
RESTRICTED USAGE: I do not give permission for my child's image to be used in any capacity by Grace Youth or Grace Community Church.

Medical Conditions

Does your child have any serious allergies/medical issues that may require emergency action to be taken by the ministry personnel?

If yes, please explain.

Is your child bringing any medication with them?

If yes, please explain.

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

If yes, please explain.

Please list the name, phone number, and relationship to the child of two emergency contacts if you cannot be reached in an emergency. *

By checking this box, I authorize one of the Grace Community Church 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 student named above. *

Code of Conduct Agreement

By checking this box, I have read and agree to the Grace Kids Code of Conduct described below. I have also briefed my child on the outlined expectations. *

Students participating in Grace Kids Senior programming must demonstrate respect to the leaders, the space, themselves, and each other at all times. Inappropriate behaviour will be corrected. If, in the view of the leaders, the offence is severe, the parents will be contacted and a plan will be made in conjunction with our Kids Co-Directors Charlene Nurmi and Annica Napier. The following actions will lead to being sent home:
sexually explicit talk/behaviour, refusing to follow the direction of a leader, overtly hateful speech, the consumption or possession of alcohol, drugs or any illegal item or substance, any behaviour that is considered immoral and/or illegal.

By checking this box, I am indicating that all the above information is correct to the best of my knowledge, and that if something changes, I will inform the GK Co-Directors as soon as possible. *

Release of Liability Agreement

By checking this box, I agree to the following release of liability statement: *

I undertake and agree to indemnify and hold blameless, Grace Youth Ministry Staff and volunteers, Grace Community Church, its Pastors, Leadership Board members, and Elders from and against any loss, damage or injury suffered by the student participant as a result of being part of the activities of Grace Community Church, whether on Grace Community Church property or at an off-campus event, such as a bowling night, as well as of any medical treatment authorized by the supervising individuals representing the church. I/we understand there are risks in participating in any activity. This consent and authorization is effective only when participating in events hosted by Grace Community Church.

Thank you for filling out our annual consent form!

If you have anything you would like to clarify or have further questions, please reach out to our Co-Directors of Children's Ministries: Annica Napier (annica@gracecommunity.ca) and Charlene Nurmi (charlene@gracecommunity.ca)

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