Calvary Kids Parent Consent - Long Form

Child Information

Name

Address

Birthdate

Grade

Child Medical Information

Does the child you are registering have any allergies, dietary concerns, medical conditions or disabilities that we need to be aware of?

Yes No

If you marked yes above, please explain:

Health Card Number

Family Doctor's Name

Family Doctor's Phone Number

Parent/Guardian Information

Parent/Guardian Name

Second Parent/Guardian Name

Parent/Guardian Email

This address will receive a confirmation email

Parent/Guardian Primary Contact Number

Parent/Guardian Secondary Secondary Contact Number

Parent/Guardian Mobile Updates Opt In - You will receive periodic text updates including email alerts and bad weather program updates.

Yes No

Additional Information - Is there any other information we should be aware of to safely take care of your child (eg. legal custody agreements, behavioural strategies etc)?

Emergency Contact Information

Emergency Contact Name

Emergency Contact - Relationship To Child

Emergency Contact Phone Number

Consent & Parental Agreement

Please read the following conditions carefully, and contact us at kristine@calvarygravenhurst.com if you have any questions.

Medical Care Release - The safety of your child is our primary concern. Precautions will be taken for their well-being and protection. I agree to any emergency treatment to be given as considered necessary. I undertake and agree to indemnify and hold harmless Calvary Gravenhurst and its leaders from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Calvary Gravenhurst, as well as of any medical treatment authorized by the supervising individuals representing Calvary Gravenhurst.

Yes

Ministry Care Release - Calvary Gravenhurst believes in excellence in our entire Children’s Ministry Department. It is always our endeavour to care for your child(ren) to the best of our ability while they are entrusted to us. At any time, we reserve the right to not admit your child into the classroom should there be signs of any communicable disease or sickness i.e. colds etc. Your child(ren) will only be released to the parent/guardian and/or those whom you have authorized above.

Yes

Media Release - I agree to photographs and short videos of activities including my youth to be taken for use within the church community and for possible public publication.

Yes No

Digital Signature

I have read, understood and agree with all of the above and sign this consent form to cover all Calvary Kids Program activities for September 2023 - September 2024. I understand that if any information on this form changes, it is my responsibility as a parent/guardian to make the organizers aware in writing so that changes can be made to Calvary Gravenhurst's database.

I understand that if I wish to withdraw my consent at anytime, I must do so in writing to Calvary Baptist Church (Calvary Gravenhurst) and give adequate time for processing.

Digital Signature of Parent/Guardian

Date of Signature of Parent/Guardian

Description

Please fill out this form for each individual child and click submit.

Calvary Kids Parent Consent - Long Form

Description

Please Fix the Following