GPAC Youth Authorization Form 25/26

For the period of September 1, 2025 through August 31, 2026. Grande Prairie Alliance Church – Youth Ministry, Grade 6-12

Your name *

Email address *

Student Information

Student Name (Full Name) *

Grade *

Gender *

Birthday *

Address *

Alberta Health Care Number *

Family Doctor's Name *

Family Doctor's Phone Number *

Does your child have any allergies? *

Does your child have any physical, emotional, mental, or behavioural concerns or limitations that our staff should be aware of? *

Does your child travel with any medications? *

Parent/Guardian Information

Phone number *

Emergency Contact

Emergency Contact Name *

Phone number *

Medical

I/We, the parents or guardians named above, *

authorize Pastor Lauren Farrow, or one of the Grande Prairie Alliance Church youth ministry volunteer staff to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above, given the parents/guardian are unable to be contacted or present.

Damage & Injury

I/We, the parents or guardians named above, *

undertake and agree to indemnify and hold blameless the Grande Prairie Alliance Church, its Pastors, Board of Elders and youth ministry staff from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of the Grande Prairie Alliance Church youth ministry, as well as of any medical treatment authorized by the supervising individuals representing the church.

Transportation

I/We, the parents or guardians named above, *

give permission for our child, named above, to be driven to events by the youth ministry and volunteer staff of Grande Prairie Alliance Church. Grande Prairie Alliance Church and the volunteer staff are hereby released from any liability in the event of accident or misfortune that may occur while on the youth outings.

Photograph and Film

I/We, the parents or guardians named above, *

hereby give consent to the Grande Prairie Alliance Church Youth ministry to take pictures and videos of the student named above. I also give consent to use the pictures and videos online, in promotional videos, and church publications. I understand that my consent may be withdrawn at any time upon written notice to laurenf@gpalliance.ca

Parent/Guardian and Participant Authorizations

I/We, the parents or guardians named above, *

have read, understood and agree with all of the above, and hereby authorize the leaders of the Grande Prairie Alliance Church youth ministry to act on my behalf with respect to my child listed above:

Name of Parent/Guardian Signing This Authorization *

I, the student named above, *

agree to submit to the authority of the Grande Prairie Alliance Church youth ministry while under their supervision, and agree to abide by whatever decisions they deem necessary:

Name of Student Signing This Authorization *

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