Children’s Ministry Form

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Children & Youth Programs Registration Form – 2016/2017





Family and Parent/Guardian Information

Parent/Guardian Name:      Relationship:

Home Phone:      Cell Phone:

Email:

Parent/Guardian Name:      Relationship:

Home Phone:      Cell Phone:

Email:

Mailing Address:

City:       Postal code:

Purposes and Extent

Charlie Lake Community 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 Charlie Lake Community Church to limit the information collected, or to view your child’s information, please contact us.

Medical Release

Every precaution is taken for the safety and good health of your child, but in the event of accident or illness, Charlie Lake Community Church, its staff, and its volunteers are hereby released from any liability. In the event that a child requires medical attention, parents/guardians will be notified immediately.

In case of emergency, I/We, the parents or guardians named above, hereby give permission to the ministry staff of Charlie Lake Community Church to give consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment, or procedures for the children listed on page 2 of this form. I/We agree to indemnify and hold blameless the ministry staff, Charlie Lake Community Church, its pastors and Board of Elders from and against any loss, damage, or injury suffered by the participant(s) as a result of being part of the activities of the 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 events of the Charlie Lake Community Church.

Parent/Guardian Signature (please type in name):       Date:

As all of our programs are volunteer run, we encourage parents to get involved where they can.
Please indicate below any area(s) you would be willing to serve in.

Before Church ChildcareSunday SchoolNursery

Children’s Information

Child #1

Full Name:      Name Child Goes By:

Gender: MF     Birthday:    Age:    Grade:    School:

BC Care Card Number:

Medical Concerns/Allergies:


Child #2

Full Name:      Name Child Goes By:

Gender: MF     Birthday:    Age:    Grade:    School:

BC Care Card Number:

Medical Concerns/Allergies:


Child #3

Full Name:      Name Child Goes By:

Gender: MF     Birthday:    Age:    Grade:    School:

BC Care Card Number:

Medical Concerns/Allergies:


Child #4

Full Name:      Name Child Goes By:

Gender: MF     Birthday:    Age:    Grade:    School:

BC Care Card Number:

Medical Concerns/Allergies:


Child #5

Full Name:      Name Child Goes By:

Gender: MF     Birthday:    Age:    Grade:    School:

BC Care Card Number:

Medical Concerns/Allergies:


Media Release

I give permission for my child(ren), to be (please check appropriate boxes):

photographed during church activitiesvideotaped during church activitiesmy child's image may appear in print or online promoting the church's activities, including on the church's website, promotional brochures, worship presentations, announcement slides, and on the church's Facebook page.

I understand that my child’s name will not be used to identify my child. This permission form will be kept on file in the church office. If I would like to withdraw this permission, I may do so at any time.

Parent/Guardian Signature (please type):      Date:


Child & Youth Release Permissions

As a part of our Plan To Protect, only the parent/guardian who signs a child in to a program or activity may sign that child out. However, we understand that occasionally circumstances arise and you find it is necessary to have someone else pick up your child. Please list below any individuals over the age of 16 who are authorized to sign your child(ren) out of our Nursery or Discovery Time programs.