HIGH SCHOOL STUDENT MINISTRIES

High School Ministries (HSM) is for students in 9th – 12th grades.

We meet on Sunday nights (September – April) in the youth room, which is located in the church’s lower level. Our goal for our high school ministry would be authentic community – meaning we strive to be a real place where you can explore your faith and grow deeper in your relationship with God – wherever you are/whoever you are. Our meetings vary. We meet in the youth room for worship, games, food, lesson and a chance to connect with a small group of students. We also have special event nights and small group nights. Since our schedule is always changing, please check out our calendar and see what's up.

Faith Seekers is a weekly Sunday morning class for High School students (grades 9 – 12). The students meet immediately after the morning service until 11:30 am.
Faith Seekers is a time for these students to seek a deeper understanding of the core beliefs of the faith and applying them to their everyday life.

Got questions about the Youth Ministry? Email our Youth Director, Jess Van Zee at jess@bentheim.org or go to… Bentheim Youth Ministries Facebook

Student Ministries Parent Consent for Medical Treatment

Bentheim Reformed Church 3997 38th St., Hamilton, MI 49419

Step 1 of 4

25%

Effective dates: September 1, 2023 to August 31, 2024

Please print in ink

Student Info:

Name(Required)

First Middle Last

Age(Required)

Year in School(Required)

Sex(Required)

Male

Female

Birth Date(Required)

MM slash DD slash YYYY

Address(Required)

Street Address Address Line 2 City State ZIP Code

Student Cell(Required)

Student Email(Required)

Parent Info

Mother's Name(Required)

First Last

Phone(Required)

Father's Name(Required)

First Last

Phone(Required)

Parent Email(Required)

Emergency contact (other than parents)(Required)

Phone(Required)

Medical insurance company(Required)

Policy #(Required)

Physician(Required)

Office Phone(Required)

Dentist(Required)

Office Phone(Required)

Medical History

If necessary, describe in detail the nature and severity of any physical and/or psychological ailment, illness, propensity, weakness, limitation, handicap, disability, or condition to which your child is subject and of which the leaders should be aware, and what, if any action of protection is required on account thereof. Submit this notification in writing and attach it to this form. Include names of medications and dosages that must be taken.

Check the following areas of concern for this student. If necessary, add another page with details:

1. For your child’s safety and our knowledge, is your student a⎯(Required)

good swimmer

fair swimmer

non-swimmer

2. Does your child have allergies to⎯

pollens

medications

food

insect bites

Allergies to Medication

Allergies to Food

3. Does your child suffer from, or has ever experienced, or is being treated currently, for any of the following:

asthma

epilepsy / seizure disorder

heart trouble

diabetes

frequently upset stomach

physical handicap

4. Date of last tetanus shot:

5. Does your child wear:

glasses

contact lenses

6. Please list and explain any major illnesses the child experienced during the last year:

Additional comments:

Should this child’s activities be restricted for any reason? Please explain:

For your information, we expect each student to conform to these rules of conduct

No possession or use of alcohol, drugs, or tobacco
No students can drive
No fighting, weapons, fireworks, lighters, or explosives
No offensive or immodest clothing
No boys in girls’ sleeping quarters and no girls in boys’ sleeping quarters
Participation with the group is expected
Respect property
Respect one another, staff, and adult leaders
Respect and comply with event schedules

Students who fail to comply with these expectations may be sent home at their parents’ expense.

Note: If you desire to limit your child’s participation in any event, please submit your wishes in writing to the church youth pastor prior to that event.

Name of Student(Required)

First Last

has my permission to attend all youth activities sponsored by BENTHEIM REFORMED CHURCH (herein after named “Church”) from September 1, 2023 to August 31, 2024.

This consent form gives permission to seek whatever medical attention is deemed necessary, and releases the Church and its staff of any liability against personal losses of named child.

I/We the undersigned have legal custody of the student named above, a minor, and have given our consent for him/her to attend events being organized by the Church. I/We understand that there are inherent risks involved in any ministry or athletic event, and I/we hereby release the Church, its pastors, employees, agents, and volunteer workers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my/our child’s involvement. In the event that he/she is injured and requires the attention of a doctor, I/we consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a physician and/or hospital personnel designated by the Church, I/we agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I/We also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. Further, I/we affirm that the health insurance information provided above is accurate at this date and will, to the best of my/our knowledge, still be in force for the student named above. I/we also agree to bring my/our child home at my/our own expense should they become ill or if deemed necessary by the student ministries staff member.

Parent/guardian signature(Required)

First Last

Date(Required)

MM slash DD slash YYYY

Photo Release

Check ONE:(Required)

DO give permission for Bentheim Reformed Church to use, reproduce, and/or distribute photographs, films, video, and sound recordings of my child without compensation or approval rights, for use in social media, printed and website materials created for purposes of promoting Bentheim Reformed Church.

I DO NOT give permission for Bentheim Reformed Church to use, reproduce, and/or distribute photographs, films, video, and sound recordings of my child without compensation or approval rights, for use in social media, printed and website materials created for purposes of promoting Bentheim Reformed Church.

MEMBERS

HIGH SCHOOL STUDENT MINISTRIES

Student Ministries Parent Consent for Medical Treatment

Student Info:

Parent Info

Medical History

Photo Release

Morning Service 9:30am

Evening Service: 5:00pm

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