Insurance Company and Policy #
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Please type none if the child does not have insurance.
Do any of your children have any other allergies or any life-threatening allergies? If so, what? Describe exactly what has happened in the past when the child was exposed to this allergen.
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Please list each child and their additional allergies. Please type na if this does not apply.
Do any of your children need to check in emergency medications? If so, what? Describe in detail what needs to be done in the event of an emergency.
Please list each child and their needed medications.
Do any of your children have any physical, emotional, mental, or behavioral concerns or limitations that our staff/volunteers should be aware of? If yes, please explain.
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Please list each child. Type na if this does not apply.
Have any of your children ever had seizures, asthma or heart disease?
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If so, please list which child and what condition. Type na if this does not apply.
In the case of an emergency, I understand that hospital policy requires parental permission before treatment. I hereby give my permission to a representative of Light of Christ Church to secure proper medical treatment. Parents will be notified immediately.
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Please type your full name and the date.
Photo Use Policy
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Light of Christ UMC requires a signed release form from the subject of any photograph or image used on web sites or other forms of publication. This form may be printed and completed by individuals who wish to submit photographs for publication or who may be the subject of photographs to be published. Light of Christ UMC will not publish any image of a minor unless his or her parent or legal guardian has signed a permission form. Group photographs do not require consent before publication.
Photo Release and Consent Form – Light of Christ UMC
I hereby grant permission to Light of Christ United Methodist Church to use my image (photographs and videos) on its website and other church publications without further consideration. Permission is also granted to use images of my children and/or youth listed below. I understand that no names will be used on the website or in publications unless specific permission, verbal or written, is given to an appropriate staff member.
I understand that once any image is posted to the Light of Christ United Methodist Church website, the image can be downloaded by any computer user around the world.
I release the staff and volunteers of Light of Christ United Methodist Church from any liability connected with the use of my picture or video as part of any of the above or similar activities.
I hereby attest that I am the legal parent or guardian of the children listed below. This consent is effective until such time as I revoke it in writing and provide a copy of the revocation to Light of Christ United Methodist Church.
