Sept 2023 - Aug 2024 Child Registration Form - Whyte Ridge Baptist Church (Appendices 15a)

Registration is required for all Children's Programming for kids attending Nursery to Grade 6.

Please complete one application per child. Thank you.

CHILD INFORMATION

Child Name:

Birthdate

Gender

Male Female

Age

PARENT / GUARDIAN INFORMATION

Parent / Guardian First Name

Parent / Guardian Last Name

Relationship to Child:

Address

This address will receive a confirmation email

Home Phone

Mom Cellular Number (if applicable):

Dad Cellular Number (if applicable):

Mom Work Number (if applicable):

Dad Work Number (if applicable):

IN CASE OF EMERGENCY (If parents/guardians are not available)

Emergency Contact Name

Emergency Contact Relationship to Child

Emergency Contact Phone #

I give my permission for my child to be released at the close of the program to the following adults (please list, separated by commas):

AUTHORIZATION AND MEDICAL CONSENT

Information received is confidential and is being gathered for the purposes of serving your child while in the care of Whyte Ridge Baptist Church. Any medical information collected here serves to authorize Whyte Ridge Baptist Church, and its staff and volunteers, to obtain medical assistance in emergencies. In the case of custody agreements, please include the proper form authorizing parental contacts. The following information is for the school year 2023 / 2024:

Health Card # (Reg # - 6 Digits):

Health Card # (PHIN# - 9 Digits):

Family Doctor Name:

Family Doctor Phone #:

Please List Any Allergies (Enter "None" if Not Applicable):

• Please list any medications, physical, emotional, mental, behavioural concerns or limitations staff should be aware of (if none, leave blank):

NOTE: No medications will be left with the child unless for life threatening situations. Any medication to be left in your child’s possession must be indicated in the ‘Special Instructions’ section above. Parents must be available for emergency situations.

PERMISSION FORM AND CONSENT

I/we, the parents or guardians named, authorize one of the Whyte Ridge Baptist Church Ministry Staff 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 above, undertake and agree to indemnify and hold blameless the Ministry Staff, Whyte Ridge Baptist Church, its Pastors and Board of Church Management 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 church. This consent and authorization is effective only when participating in or traveling to and from events of the Whyte Ridge Baptist Church.

I agree Please contact me regarding this

Communication:

A policy is in effect that communication is to be used solely for the dissemination of information. 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:

Telephone (home/work/cell) Social Media Networks Email Text Messages Please contact me regarding this

Photos:

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

Printed material Video recording Social media Website All of the Above Please contact me regarding this I do not give permission for use of photos of my child

Purposes and Extent:

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.

Parent/Guardian Options:

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-YYYY)

Sept 2023 - Aug 2024 Child Registration Form - Whyte Ridge Baptist Church (Appendices 15a)

Description

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