FIRST Student Ministry Students Name _____________________________ Student Phone #_____________Grade _____ Address _____________________________________________________________ DOB _____ Parents Name (Legal Guardians) ______________________________________________________ Relation ____________________
Phone ___________________ (qhome qcell)
Phone ___________________ (qhome qcell)
Email ____________________________________ [Please provide the email address you use the most often.] ------------------------------------------------------------------------------------------------------------------Emergency Contact ________________________________________________ Relation_________________
Insurance Number _____________________________________ Provider _________________________________________________ Provider Phone ______________________ Dr. _________________________________________________
Health Concerns / Medications (attach additional pages if needed) ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ This consent form gives permission to seek whatever medical attention is deemed necessary, and releases FBC Douglasville and its staff of any liability against personal losses. I, the undersigned, willingly allow my son/daughter _____________________________ to participate in events/programs organized by First Students Ministry. In the event that he/she is injured and requires the attention of a doctor, I consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a physician and/or hospital personnel designated by the Church, I agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I also acknowledge that I will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. Further, I affirm that the health insurance information provided above is accurate and active for any care my child may require. Signature of Parent/Guardian ________________________________________ Date __________ This form will be kept on file in the youth pastor’s office in the church, and will be taken on each trip as needed. You do not need to fill out a new form this year, unless there are changes. Please return, signed and completed, to the youth department. Thank you.
State of Georgia: County Of Douglas: Subscribed and Sworn to before me on this ___________day of ___________, 2018 Notary Public My Commission Expires
Guardian Release for Student Events I give permission for my child, _______________________________________, to participate in all activities planned by First Student Ministry. I support the Youth Pastor and adult leaders chaperoning these activities, and I give them permission to take reasonable action, as they deem necessary, to protect the best interest of my child. _______________________________________________ Parent/Guardian Signature
Student Covenant The following is a statement of conduct for all youth activities (events, bible studies, trips, etc) that is to be read and signed by both student and parent. I, ____________________________, agree to abide by the following code of conduct during all youth activities (events, bible studies, trips, etc). I WILL RESPECT EVERYONE. • I will respect, listen to, and cooperate with all youth leaders, chaperones, drivers, and any other adult at all times. • I will respect and strive to build up each person in our youth group, visitors, and others. • I will not bully, gossip, harass, intimidate, demean, prank, physically attack, verbally abuse, threaten (verbal or written), make jokes or innuendos about ANY person at ANY time. Bullying will NOT be tolerated under any circumstances. • •
I will listen when others are speaking, as I want to be listened to in the same manner. I will not disrupt teaching times, Sunday school times, etc, with pranks, goofing around, or other obscene behavior.
I WILL RESPECT PROPERTY. • I will respect all property that belongs and does not belong to me. I will not steal, destroy, or hide things that do not belong to me. • I will not sit on tables, play rough with games, and be rough on furniture in the youth room. • I will help clean up any trash left in the youth room – especially my own. • I will not be rough, destroy, or trash up any other space used outside of the youth area. This includes other parts of FBC Douglasville and places we are guests. I WILL RESPECT MYSELF. • I will refrain from all improper behavior, including using illegal drugs and alcohol. • I will refrain from using profanity – this includes racial slurs and derogatory comments. • I will not bring weapons to any youth group activities, unless given permission by the Youth Pastor first. • I will not bring harm to myself, or others. • I will not leave the supervisory presence of adult leaders without prior permission from them – i.e. leaving youth meetings, leaving church grounds, leaving the group during trips, etc.
I will dress modestly during all youth activities. If I do not, I understand that I will be given appropriate clothing to borrow during said activity. This includes all students and adults. o No inappropriate words, slogans, symbols, or advertisements on clothing o Males – when you are in mixed company, keep your shirts on. Please keep your underwear / boxers from being exposed (pull up your pants and shorts). o Females – no spaghetti strap shirts unless they are part of a layered outfit. Please keep your bra straps underneath clothing. Please wear shorts that fully cover everything underneath them. o Males – when swimming, you are expected to wear swim trunks o Females – when swimming, you are expected to wear a one-piece suit or a twopiece suit that covers your stomach. If you wear a two-piece the top must be stitched to the bottom so that the top does not come up. Please remember that modesty is the key here. That means that even if a student wears a one piece that student may be asked to put on a t-shirt and/or shorts if the leaders deem that suit too revealing.
I WILL HONOR CHRIST. • I will reflect a Christian attitude in all my personal relationships during all youth activities, as well as in public. Public Displays of Affection (PDA) are NOT permitted during any youth activity (events, bible studies, trips, etc). This includes but not limited to kissing, forms of cuddling, and any action sexual in nature. • I will reflect a Christian attitude every place I go, knowing that I am a light for Christ. All students are expected to participate in all planned activities, unless given written permission from Parent/Guardian, and/or verbal permission from the Youth Pastor. All students are solely responsible for their actions. Failure to comply with this covenant results in one or more of the following actions: • Meeting between student(s), parent(s), and Youth Pastor • Being sent home from said activity at Parent/Guardian expense • Being dismissed from next youth activity – time determined between Youth Pastor, Youth Leaders, and Parent/Guardian Student Name
Student Signature ________________________________________ Parent Name
If there is any question, conflict, or comment about the implementation of this Student Covenant, please contact the Youth Pastor, Jamie Wynn directly at 770-942-5481 ex108, or 404-323-9070. At FBC Douglasville we believe strongly in dealing with conflict in a biblical manner based on Matthew 5:23-25, which tells us to handle matters quickly and directly with the person in question. Thanks for your partnership in making First Students Ministry safe for all people & a shining example of Jesus Christ to those around us.
This form will be kept on file in the youth pastor’s office. Every student MUST fill out this form. Please return signed to the youth department. Thank you.
I, _______________________________________, give my permission for First Baptist Church of Douglasville to use my child’s picture on their website, social media sites, and for media releases (web & print) in which to advertise a church event. _______________________________________________ Parent/Guardian Signature
I, _______________________________________, do not give my permission for First Baptist Church of Douglasville to use my child’s picture under any circumstances. _______________________________________________ Parent/Guardian Signature