Montrose Church Parental Consent 2025-26 (Short)

To be completed by parent or legal guardian.

Your name *

Email address *

Phone number *

Child Information

In the event that medical intervention is needed on behalf of my children, named below, I understand that every attempt will be made to reach their emergency contact. In the event I/they cannot be reached in an emergency, I hereby give permission to the physician or dentist selected by the activity leader to hospitalize, to secure medical treatment and/or to order an injection, anesthesia, x-ray, or surgery for my child as deemed necessary from January 1, 2025 through July 31, 2026.

Child #1 *

Please enter the child's full name.

Emergency Contact Information

Emergency Contact (1) *

Please enter the Emergency Contact's full name.

Emergency Relation (1) *

Please enter the relationship to the child: parent, guardian, aunt, sister, etc.

Emergency Phone (1) *

Please enter in the format 999-999-9999.

Emergency Contact (2) *

Please enter the Emergency Contact's full name.

Emergency Relation (2) *

Please enter the relationship to the child: parent, guardian, aunt, sister, etc.

Emergency Phone (2) *

Please enter in the format 999-999-9999.

Digital Consent & Signature

By signing below, I authorize this Emergency Consent on behalf of my children listed above. In addition, I understand that my child’s photo or video may be taken at church activities and I authorize Montrose Church to post this media on the church website or use them in other church materials.

Consent *

Yes! I certify that I am the parent/legal guardian of the child(ren) named above and am authorized to provide consent on their behalf.

Digital Signature *

My typed name below serves as my digital signature.

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