SGAC KIDS Registration Form

Full Name of Parent/Guardian #1*

First NameLast Name

Cell Phone Number*

Format: (000) 000-0000.

Full Name of Parent/Guardian #2

First NameLast Name

Cell Phone Number

Format: (000) 000-0000.

Address*

Street Address

Street Address Line 2

CityProvince

Postal Code

Home Phone Number*

Format: (000) 000-0000.

E-mail*

example@example.com

Please list children in order from oldest to youngest:

Rows	Child's First & Last Name	Birthdate (M/D/Y)	Grade	Male/Female
1
2
3
4
5
6
7
8

Is there anyone who does not have permission to pick up your child (i.e. custody concern)?*

Are there any allergies or medical conditions?*

If yes please list child and allergy/condition:

I would be willing to volunteer in Children's Ministries.*

Spruce Grove Alliance Church (SGAC) is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to assign the child to the age appropriate classes, to develop and nurture ongoing relationships with you and your child, and to inform you of upcoming programs and opportunities at the church. This information will be maintained permanently as it is a requirement of our insurance company and legal counsel. If you wish SGAC to limit the information collected, or to view your child’s information, please contact us. I/we understand the purpose of which my child’s information will be used.

Please select one for the above, stating that you understand the purpose of which your child's information will be used.*

YesNo

I/We authorize SGAC Children’s Ministry staff to approve and obtain any and all medical attention and medical staff in the case of a medical emergency; with the understanding that all reasonable attempts have been made to consult with myself beforehand except in the case of minor illness and/or first aid where deemed appropriate; with the understanding that I will take responsibility for any additional expenses that may result from such services.

Please select one for the above, stating that you release the Western District of The Alliance Canada, SGAC, its Elders, volunteers, staff and agents from any loss, personal injury, accident, misfortune or damage to the health and safety of the above named.*

YesNo

Please select one; I/we understand that SGAC, its staff or agents reserve the right to dismiss a participant who is in their opinion a hazard to the safety and well-being of others, who appears to have rejected the reasonable guidelines of the activity.*

YesNo

I/we the parent(s) or guardian(s) agree to permit the use of phots and /or videos of the applicant in promoting the church and /or the church activities and programs within the church.

Please select one; I/we the parent(s) or guardian(s) agree to permit the use of photos and /or videos of the applicant in promoting the church and /or the church activities and programs within the church.*

YesNo

Please select one; I/we the parent(s) or guardian(s) agree to permit the use of photos and /or videos of the applicant in promoting the church and /or the church activities and programs on the website or other SGAC online streaming and Social Media services.*

YesNo

Signature

Date

SGAC KIDS Registration Form: