If you do not know the answers to any of these questions, type "don't know" in the box.

Church families are often good sources of support during a crisis.

If you do not know the answers to any of these questions, type "don't know" in the box.

If you do not know the answers to any of these questions, type "don't know" in the box.

To add more siblings, click on the + sign at right and add as many lines as you need.

If there is more than one adult and you have not listed them in a previous question? You can click on the + sign at right to add as many lines as you need for adults living in the home with the child.

Include any family or non-family members who have NOT been listed above, who have a close relationship with the child, such as a pastor, youth pastor, relative or family friend.

Need more lines? Click on the + sign to add as many as you need.

If you need more lines, click on the + sign to add as many as you need.

I understand the information will Bethel to obtain/release medical, psychological, legal or other information for the child listed in this Release of Additional records. I understand any information obtained/released will be used to determine present and/or future needs for the well-being of this child. All information will be placed in the child’s private file and will only be available to appropriate personnel and/or agencies. This consent for release is given freely, voluntarily, and without coercion for one year from the date of signature.

This authorization is valid for one year from the date signed below.

If you need to add more lines, click on the + at right. Add as many additional lines as you need.

To add additional lines, please click the + sign at the right side.