Hazelglen Alliance Church 2018-2019

Authorization, Medical Consent, Photograph Release Form

We protect and respect your privacy. Your personal information will be used only to communicate within our organization.


The safety of your child is our primary concern. Precautions will be taken for their well-being and protection. If I/we or my designated emergency contact cannot be reached, I/we, the parent or guardian named above, authorize the staff of Hazelglen Alliance Church 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 in an emergency situation.

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

This consent and authorization is effective only when participating in or travelling to events of Hazelglen Alliance Church. I/we have read and understand the information provided with this form. I/we understand that there is a degree of risk involved in some activities. After carefully considering all the risks involved, and have full confidence that reasonable precautions will be taken for the safety and well-being of my child, I/we authorize the participation of my child in all activities for the program year effective from September 1, 2018 to Aug 31, 2019.


We are sensitive to the safety and privacy of your family, at no time will the names of children accompany their photo or video image. Below is a release, for leaders and administrators to use images on social media. These photos/videos will be group or activity images.

By consenting you agree that photographs, images and/or video of my child may be used for any publications, such as Facebook, Instagram, Bulletin, or Website.

The safety of your child is our primary concern. Precautions will be taken for their well being and protection.