Toronto Chinese Baptist Church | Plan to Protect Policy
Compiled by M. Bissell (Winning Kids Inc. Copyright 2009)
Youth Ministry Authorization and Consent Form
Information received is confidential and is being gathered for the purposes of servingyour child while in the care of Toronto Chinese Baptist Church. Any medicalinformation collected here serves to authorize Toronto Chinese Baptist Church, and itsstaff and volunteers, to obtain medical assistance in emergencies.Child/Youth’s Name Date of Birth / /
(mm / dd / yyyy)
City Province Postal CodePhone Number [home/cell] ( ) Youth e-mailParents’ Phone [work/cell] ( ) Parent e-mailHealth Card NumberFamily Doctor Dr. Phone Number ( )Allergies
In case of an emergency, contact: NameRelationship to child/youth Phone # ( )
Does your child have any physical, emotional, mental, behavioural concerns orlimitations that our staff should be aware of?
NoIf yes, please explain:Is your child bringing any medication with him/her?
NoIf yes, please list. The safety of your child is our primary concern. Precautions will be taken fortheir wellbeing and protection.I/we, the parents or guardians named below, authorize Youth Pastor or one of theToronto Chinese Baptist Church Youth Ministry Personnel to sign a consent formedical treatment and to authorize any physician or hospital to provide medicalassessment, treatment or procedures for the participant named above.Please turn over…