Detailed Participation Form (DPF)

Please fill out this form and click submit. The completion of this form is necessary for all who wish to serve or participate in any LVCC Youth activities.
Longview Community Church
2323 Washington Way, Longview, WA 98632
(360) 423-6380
 
 
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Parent/Guardian Information

 
 
 
 
 
 
 
 
 
 
Alternate/Emergency Contact Person

 
 
 
 
 
I give permission for my child/student's photo to be used in...
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Insurance: If you have medical insurance, your carrier will be billed for medical charges in the case of illness or injury while your child is at the activity.
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Health History

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Please remember: If your child should require medical attention for injuries received or illnesses contracted prior to activity, please send us the necessary information to give him/her proper medical care during his/her time with the activity. 
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** Bring enough medications in sufficient quantities and in the original containers. Make sure that they are NOT expired, including inhaler and EpiPens. You SHOULD NOT STOP taking any maintenance medications unless instructed to do so by your physician.** 
Immunizations

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I understand that in the event medical intervention is needed, every attempt will be made to immediately contact the persons listed on this form. In the event I cannot be reached in an emergency during the activity dates shown on this form, I hereby give my permission to the physician or dentist selected by the activity leader to hospitalize, to secure medical treatment, and/or to order an injection, anesthesia, or surgery for my child as deemed necessary.

I understand that my insurance coverage for my child will be used as a primary coverage in the event medical intervention is needed. Coverage by Longview Community Church through its accident policy will be used as a backup for what my family's insurance does not cover.

I understand all reasonable safety precautions will be taken at all times by Longview Community Church and its agents during the events and activities. I understand the possibility of hazards and know the inherent possibility risk. I agree not to hold Longview Community Church, its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred by the subject of this form.

I understand that I am responsible for updating this record when there are changes in this information. This information will be kept confidential and will only be shared with other staff and health-care providers.

Administration of medications (except those noted) is approved by parent/guardian below:
 
 
*By entering my name in the box above, I am providing my digital signature on this Form.
Longview Community Church Children's and Youth Ministry Code of Conduct

All participants (children, youth, and adults) on ministry events for Longview Community Church are expected to help create a safe, meaningful, encouraging, and fun atmosphere where people can experience the love of God through relationships with others. Therefore, it is vital that these conduct expectations are clear. Each individual will be responsible for his or her own behavior.

Therefore, all participants (and their parents/guardians) are asked to read and sign the following Code of Conduct statement.

- The health and safety of all participants is our highest priority.
- Relational safety is also vital, so respect and kindness are expected, in both word and deed. (Bullying, roughhousing, or mean-spirited teasing will not be accepted.)
- Respect for adult leaders is also required and minors must understand that disruptive or rude behavior that distracts from the event will not be tolerated.
- To ensure great events, proper respect for the program itself and physical property is needed.
- Knowing that cell phone usage can also be a distraction, cell phones should not be used (unless as part of a planned program).
- For appropriate (and comfortable) relationships to happen, everyone will refrain from any public or private displays of affection (PDA), as well as remember that girl rooms are off-limits to boys (and vice-versa).
- Any conflict must be resolved with care and compassion, and adult leaders are committed to helping this happen well.
- Mandatory reporting laws will be followed (if there is any concern about abuse or harm to self or others).
- If violation of a law is suspected, law enforcement may be contacted. There will be absolutely no tolerance of the use or possession of alcohol, tobacco, drugs, or weapons.
- These expectations will be communicated at least annually at parent info meetings, posted at the church, communicated at the beginning of ministry events, and will be signed by minor and parent/guardian.
I will abide by these expectations and do my best to help contribute to the positive spirit of the event. I desire to be open to other people (and God's best for me) on these events, knowing that I will get out of this event in proportion to what I put into it.
 
 
*By entering my name in the box above, I am providing my digital signature on this Form.
I support my child in following these expectations. I understand that serious misconduct or infraction of rules may result in participant being sent home from the event at the family's expense. This decision will be made by staff and leaders on the event.
 
 
*By entering my name in the box above, I am providing my digital signature on this Form.

Description

Please fill out this form and click submit. The completion of this form is necessary for all who wish to serve or participate in any LVCC Youth activities.