4HG Registration Form (Grades 6 to 12) - Appendix 19 - September 2023

Whyte Ridge Baptist Church is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to assign the student to the appropriate classes, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities at our church.

This information will be maintained permanently as it is a requirement of our insurance company and legal counsel. If you wish Whyte Ridge Baptist Church to limit the information collected, or to view your child’s information, please contact us.

Please select:

4HG - Grades 6 - 12 4HG - Student Leader (Under 18)

Student / Student Leader Information:

Student / Student Leader Name:

Date of Birth: (DD-MM-YY)

Contact Information:

Address:

Home Phone:

Mobile Phone (Parent):

Parent Email:

This address will receive a confirmation email

Emergency Contact Name (if parent is not available):

Emergency Contact Phone #:

Medical Information:

Health Card # (PHIN# - 9 Digits):

Health Card # (Reg # - 6 Digits):

Family Doctor Name:

Family Doctor Phone #:

Any medications / allergies, physical, emotional, mental, behavoural concerns or limitations staff should be aware of?

***NO MEDICATIONS ALLOWED ON A CHILD WITH THE EXCEPTION OF EPI-PENS AND
PUFFERS.

Permission and Consent - Activities:

Dear Parent:

As part of our programming we are planning some activities that require your permission prior to participation. We will provide you with the details of the activities and request that you complete and sign the permission form.

The safety of your child is our primary concern. Precautions will be taken for their well being and protection. Transportation will be provided by certified drivers within our church. Dates of travel along with a listing of transportation from and to locations are listed in Appendix 19b (The letter of consent for off-site activites / transportation, which you will receive a link to once registration is complete). Our minimum requirement is to have one certified driver along with at least one other minor in their vehicles with departures and arrivals monitored by a 4HG staff member. Events beyond reasonable risk will require a special waiver form (rock climbing, skiing, laser tag, etc.)

While every precaution is taken for the safety and good health, some activities including transportation carry with them the inherent risk of personal injury. Dates of travel along with a listing of transportation from and to locations are listed in Appendix 19b (The letter of consent for off-site activites / transportation). Your permission is required to provide this transportation. Please carefully read the following information and consent form.

If you are in agreement, please agree to the following and click 'submit':

I give permission for my child/charge (“child”) to be transported in a motor vehicle driven by a certified driver to an event at the specified location on the date indicated. I understand that my child is expected to follow all applicable laws regarding riding in a motor vehicle and is expected to follow the directions provided by the driver and/or other adult volunteers. I understand that participation in the identified event is not a requirement for participation in Whyte Ridge Baptist Church activities. I have read, understand, and discussed with my child that: (1) They will be travelling in a motor vehicle driven by an adult, with at least one other minor with them, their arrivals & departures will be monitored by a 4HG staff member and that they are to wear their safety-belt while travelling; (2) They are expected to respect each other, the vehicles they ride in, and the people they travel with during the trip; (3) Riding in a motor vehicle may result in personal injuries or death from wrecks, collisions or acts by riders, other drivers, or objects; and 4) They are to remain in their seats and not be disruptive to the driver of the vehicle. I recognize that by participating in this activity, as with any activity involving motor vehicle transportation, my child may risk personal injury or permanent loss. I hereby attest and verify that I have been advised of the potential risks, that I have full knowledge of the risks involved in this activity, and that I assume any expenses that may be incurred in the event of an accident, illness, or other incapacity, regardless of whether I have authorized such expenses. While every precaution is taken for the safety and good health, some sports and activities carry with them the inherent risk of personal injury beyond the risks associated with many of the recreational activities at Whyte Ridge Baptist Church. I/we understand and accept these risks and agree that by allowing my child to participate in those activities, he/she may be taking part in a recreational activity that presents the potential for personal injury.

Yes Please contact me regarding this

I/we, the parents or guardians named below, authorize the Director or one of the Whyte Ridge Baptist Church Personnel to sign consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above.

Yes Please contact me regarding this

I/we, named below, undertake and agree to indemnify and hold blameless Whyte Ridge Baptist Church, its personnel, its Directors and Board from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of the Whyte Ridge Baptist Church, as well as of any medical treatment authorized by the supervising individuals representing the Whyte Ridge Baptist Church. This consent and authorization is effective only when participating in or travelling to events of the Whyte Ridge Baptist Church.

Yes Please contact me regarding this

Permission and Consent - Communication:

I grant permission for Whyte Ridge Baptist Church program personnel (staff and volunteers) to communicate with my child via telephone, email, social media and text as indicated: (NOTE: A policy is in effect that communication is to be used solely for the dissemination of information.)

Telephone (home/work/cell) Social Media Networks Email Text messages Please contact me regarding this All of the above

Permission and Consent - Photos:

I grant permission for the use of pictures containing my child at WRBC events and activities in any or all of the following ways:

Printed material Video Recording Social Media Website Church Use Please contact me regarding this All of the above

Parental Consent:

I have read, understood, and agree with the above and sign it to cover all children’s/youth program activities for the program year effective as stated below. A separate Informed Letter of Consent will be sent home for off-site activities and activities of elevated risk.

By entering my name, I am indicating my acceptance and delivery of this information.

Date: (DD-MM-YY)

Office Use Only:

Youth Ministry Registration Status Registration Completed Registration Pending Registration Required

4HG Registration Form (Grades 6 to 12) - Appendix 19 - September 2023 - August 2024

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4HG Registration Form (Grades 6 to 12) - Appendix 19 - September 2023 - August 2024

Description

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