Hinsdale Covenant Child Protection Consent Form

Parent/Legal Guardian Consent for Participation and Understanding of Safety Policies at the Evangelical Covenant Church of Hinsdale
 
 
 
 
 
 
 
 
 
Pickup Policy

Please list any parents, guardians or caregivers that have your consent to pickup your child (children) from any of our children’s ministries programs. (Please note, any person(s) listed here must be 18 years or older). In certain case ID may be required.
 
 
 
 
Sick Child Policy

It is our desire to provide a healthy and safe environment for all of the minors in our care. Parents are encouraged to be considerate of others when deciding to place a minor in our care. In general, minors with the following symptoms should not be dropped off:

- Fever, diarrhea, or vomiting within the last 48 hours
- Green or yellow runny nose
- Eye or skin infections
- Other symptoms of communicable or infectious disease

Minors who are observed by our staff members or volunteers to be ill will be separated from the other minors and the parent or guardian will be contacted to request that the minor be picked up.
Please select all that apply.
Allergy or Health Concerns

 
 
 
 
Accidental Injuries

In the event a minor is injured while in our care, the following steps should be followed:
1. For insignificant injuries, scrapes, and bruises, workers will provide first aid as appropriate and will notify the minor’s parent or guardian of the injury at the time the minor is picked up.
2. For injuries requiring medical treatment beyond simple first aid, the parent and/or guardian will immediately be summoned. If warranted by circumstances, an ambulance can be called by parent/guardian or worker.
3. Once a minor has received appropriate medical attention, an Accident/Injury Report Form will be completed and kept on file at the church.
Please select all that apply.
Restroom Guidelines for Adults Caring for Children in the Nursery/Little Lambs

Because the Evangelical Covenant Church of Hinsdale seeks high safety standards to protect the children who participate in our programming, we are requesting your informed consent regarding your child's restroom or toileting needs when he/she is under the care of the nursery/toddler room. The members of the staff of these rooms have been instructed and trained according to the Restroom Guidelines below.

The staff and volunteer workers will take every reasonable precaution to provide a safe and healthy environment for all children while they are involved in the ministries of the church.

It is the policy of the Evangelical Covenant Church of Hinsdale that no staff worker, no adult volunteer, or teenage volunteer will change diapers.
Please select all that apply.
Permission for Restroom Care for Toilet-Trained Children

I give permission, when necessary, for one adult worker to escort my child to the restroom.
- In the event your child has a wetting accident, you will be notified via text message to change your child’s clothes.
Please select all that apply.
Responsibilities of Parents

Parents should take their children to the bathroom immediately prior to a scheduled church activity.

If the child is not toilet trained:

- Please make sure your child’s diaper/pull-up is dry before dropping off your child.
- You will be notified via text message to come and change your child’s diaper.
- In the event your child has a wetting accident, you will be notified via text message to change your child’s clothes.

If the child is toilet trained:
- Parents must sign the above Permission for Restroom Care for Toilet-Trained Children for an adult worker to escort the child to the restroom.
Please select all that apply.
Responsibilities and Restroom Guidelines for Staff and Adult Volunteers

A child is escorted to the bathroom only upon their request or if the child shows obvious signs of needing to go.
- When possible, a restroom break may be considered, allowing several children to go at the same time.
- When a child is being escorted to the restroom, there will continue to be proper supervision the class.
- Spend as little time as possible in the bathroom.
- The adult worker escorting the child is not to enter the child’s stall unless absolutely necessary. When modesty permits, the worker should stand in the hall, or at the hall door entrance with the door ajar. Children should be encouraged to help themselves with procedures.
- If the child requests a worker’s help in the stall, the worker should explain to the child how to help himself.
- If the worker’s help is essential, the worker should avoid direct contact with the child, and keep the stall door open. Use the “hand-over-hand” method. This technique enables the worker to place his/her hands over the child’s hands in helping with fastening clothes. The parent(s) should then be informed that extra help is needed at home teaching the child to use the facilities independently. Both worker and child should wash their hands thoroughly after toileting.
- Worker and child should return promptly to the classroom.
Please select all that apply.
Consent to the above policies and guidelines

Please select all that apply.

Description

Parent/Legal Guardian Consent for Participation and Understanding of Safety Policies at the Evangelical Covenant Church of Hinsdale