Event Permission & Health Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete this form in order for your Child to partake in DYM events

In ticking the below box you confirm that you are the parent or guardian of the child this form is for. If you are not the parent or guardian please give this form to them to fill out. If you completing this form as a leader or are the age of 19 and therefore considered legally an adult, you can click 'other' and describe your role. *

Yes, I confirm that I am the parent or guardian of this child, stated below

Other:

Required

Child's First and Last Name (Or yours if over 19) *

Child's Pronouns *

Child's Date of Birth (Or yours if over 19) *

YYYY

PHN number *

Emergency Contact 1: Please give name, relationship and contact telephone number: *

Emergency Contact 2: Please give name relationship, and contact telephone number:

Allergies and health concerns we should be aware of: *

Please note there may be special lighting used in this event including stage lighting and flashing lights, please indicate if this may be inssue for your child.

What Parts of the Event are you planning to be present at? *

The Timetable below indicates which part of the event your Child is planning to be at, this helps us with catering and checking people in and out of this event. Nearly everything on this list is optional, your child is welcome to come to any or all of these elements, however you are required to figure out a safe plan for your child to travel to and from this event, please coodinate with your parish priest or Jessica Schaap if you are having issues with transportation.

7:30pm Maundy Thursday Service (Optional)

9pm - Midnight Youth Event

Midnight - 7am Sleep over in the Cathedral

8am - Breakfast

10:30am Good Friday Service at the Cathedral (Optional)

Required

Consent for Participation: *

As the parent or guardian I hereby give consent for my child to participate in online and in person events. Online events will take place on Zoom or similar. For in person gatherings, participants will be properly supervised in all activities. In the event of accident or illness, the Diocesan Youth Movement, and the Diocese of New Westminster, its staff and volunteers are released from any liability. In the event of injury or illness requiring medical attention, by ticking the box below, I authorize appropriate treatment for the participant and understand that reasonable attempts will be made to contact me or a nominated gaurdian (listed above), should such a situation occur. The participant must be covered by provincial health insurance or equivalent medical coverage.

Yes, I authorize for my child attend this event and agree to the above waiver.

Other:

Photo Permission *

At Events held by the Diocesan Youth Movement or wider branches of the Anglican Church, our leaders or leaders associated with these organizations may be taking photos or videos of young people for publicity purposes, these may be used on websites, in publicity materials and in related publications, such as newsletters. Some services youth may attend may be broadcast Live on church websites, youtube, facebook and other video platforms, and your child might appear in that. Pictures and videos may also be used on some forms of social media for publicity as well, these may include, Facebook, Instagram or YouTube. Please indicate below the level of consent you grant for this. By signing this release, you permit the Diocesan Youth Movement, the Diocese of New Westminster and the Anglican Church of Canada to use your name and photograph in all forms of media which may result from events attended and waive the right to approve the finished product.

Yes I give permission for my child's photo/video AND name to be used

Yes I give permission for my child's photo/video to used - but not their name

I do not give photo consent but consent to the potential of my child being seen in a Live Broadcast of a Service

No, I do not grant permission for any of the above.

Other:

Permission for Diocesan Youth Events: I give permission for my child or myself to be contacted regarding this and future events related to the youth ministry of the Diocese of New Westminster:

I give permission

I do not give permission

Clear selection

Is there anything else you think we should be aware of?

Thank you from all of us at the DYM for taking the time to complete this form!

Don't Forget! Your packing list might want to include:
- Sleeping bag and mat or mattress
- Toiletries eg: toothbrush and toothpaste
- Pajamas or comfy clothes to sleep in
- Cell phone and headphones for emergencies and participation in some (not all) or prayer stations
- Face mask
- Waterbottle
- Money/Compass card if youth are using public transit

If you have any questions or cooncerns please contact either Lauren or Jessica below:
Lauren Odile Pinkney | Chair of DYM | lauren@thecathedral.ca
Rev. Jessica Schaap | Missioner for Christian Formation | jschaap@vancouver.anglican.ca

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Christ Church Cathedral. Report Abuse

Forms