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To make things easier for parents we now have a online consent form. Paper copies of consent forms are available if you prefer. All consent forms filled out online expire at the end of the year.
Student Consent Form
Consent Form Expiration 12/31/2019
Step 1 of 2
Date of Birth
Name of Parent(s) or Guardian(s)
Address Line 2
State / Province / Region
ZIP / Postal Code
Emergency Contact Name
Emergency Contact Phone
Is your student presently being treated for an injury or sickness or taking any medication?
If yes, please explain.
Does your student have, or has your student ever had, any of the following? (Please check all that apply.)
If anything is checked, please explain.
Does your student ever sleepwalk?
Student’s blood type (if known)
Does your student have a physical handicap or illness that would prevent him or her from participating in normal rigorous activity?
If yes, please explain.
Consent and Certification
I, the undersigned, being the parent or legal guardian of the student named above, do hereby consent to the participation of my student in all the scheduled student activities of Northside Baptist Church, and any other supervised activities customarily associated with its student group, including student rallies and overnight or weekend student trips. I also do hereby consent to allow photographs and/or videos of my student to be posted on social media for the purpose of promoting the ministry and activities of Northside Baptist Church student ministry. Further, I certify that my student is physically fit and adequately prepared to participate in all recreational and sporting events. If I wish to revoke this consent for any reason, I will promptly notify the Student Pastor in writing.
Note to Parent: If giving consent for one activity only, or if this consent is otherwise restricted, please specify:
Medical Treatment Authorization
In consideration of Northside Baptist Church my permitting child to participate in the activities of the student ministry, the undersigned hereby releases Northside Baptist Church, its respective directors, officers and employees of and from any and all claims whatsoever arising or which may arise by reason of the Child’s participation in the activities including any claims due to personal injuries or illness excepting any such claim resulting from and/or arising out of the gross negligence of Northside Baptist Church, its respective directors, officers or employees. Should the student suffer injury or illness while participating in student ministry activities, the undersigned hereby authorizes any representative of Northside Baptist Church and, in particular, any pastor or leader accompanying the student to authorize such medical attention for the student as may be deemed appropriate by said representative of Northside Baptist Church in the circumstances. The undersigned agrees to bear the costs of all medical care and procedures required by the student. The undersigned hereby releases Northside Baptist church, its respective directors, officers and employees from any claim arising out of any medical treatment the student may require. The undersigned acknowledges that should the student fail to keep and obey all rules and regulations prescribed by the student ministry of Northside Baptist Church, its respective directors, officers and employees, while participating, Northside Baptist Church may, in its sole and absolute discretion, terminate the student’s participation in any activity without refund for the cost. In the case of a day trip, it is unlikely that the student would be returned to the church. Were this to occur, the student would return in the company of a member of the faculty. In the case of an overnight trip, the undersigned will be contacted in advance by the Student Pastor to make the necessary arrangements to ensure that the student is properly supervised on the return trip home. Any additional costs incurred by reason of the termination of the student’s participation in any activity and/or as a result of the student being sent home will be the responsibility of the undersigned.
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