GCGCNY Children Ministry KLS Registration Form

GCGCNY Children Ministry KLS Registration Form 2021-2022
Child's Name: *

First Name Last Name
Birth Date: *

Month Day Year
Gender *

Male Female
Grade In 2021-2022: *
Is it your child's first year joining the KLS program at our church?

Yes No
Does the child have any food allergies?
Siblings Attending:
Parent/Guardian: *

First Name Last Name
Your relationship to the child *
Are you a member of GCGCNY? *

Yes No
If yes, which congregation do you belong to?

English Cantonese Mandarin
E-mail: *
Cell Phone: *

Area Code Phone Number
Are you willing to keep in touch via social media below?

Whatsapp WeChat
Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Please name anyone you authorize to pick up the child at on-site KLS Program (stating name and relationship to the child).
Release, Indemnity Agreement and Declaration

The undersigned agrees to release and discharge Grace Chinese Gospel Church of North York (GCGCNY), it’s directors, employees, agents and servants, of and from all claims of negligence or otherwise made by or on behalf of the applicants registered on the registration form, his or her guardians, or their executors, successors, administrator, against all claims, demands, judgments and costs in any way arising out of, or relating to the applicant’s participation in GCGCNY Children Ministry program.
Please select: *

Read and agreed Do not agree
We, the undersigned represent that all statement made are correct and acknowledge and agree to all terms and conditions of the applications. We further warrant that the applicant is physically capable of participating in the physical activity requested by this application.
Please select: *

Read and agreed Do not agree
Authorization

I give permission for the GCGCNY Children Ministry to take pictures or video of my child during the program. I understand that these images and video will be the property of the GCGCNY and they may use them for references and promotion of the program in the future. These images and video will also be posted on GCGCNY website and social media.
Please select: *

Yes No
Date:

Month Day Year Hour Minutes AM/PM Option

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GCGCNY Children Ministry KLS Registration Form 2021-2022