Kids Ministry - Registration Form 2023

Registration and Medical Consent Form

Mount Olive Kids Ministry
Information received is confidential and is being gathered for the purposes of serving your child while in the care of Mount Olive Evangelical Free Church. Any medical information collected here serves to authorize Mount Olive Evangelical Free Church, and its staff and volunteers, to obtain medical assistance in emergencies

Box 35 Children's Director: Alexis Goodbrand
Three Hills, AB Cell Phone: (403) 415-5931
T0M 2A0 Church Phone: (403) 443-7779
For The 2023-2024 Ministry Year

In the case of custody agreements, please include the proper form authorizing parental contacts.
Child Name*

First NameLast Name
Parent/Guardian Name*

First NameLast Name
Date of Birth*

MonthDayYear
Parent/Guardian Number*

Area CodePhone Number
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Health Card Number*
Family Doctor
Family Doctor Phone Number

Area CodePhone Number
Allergies*
YesNo
If yes, please explain.
YesNo
If yes, please list.
Pick Up

As it pertains to Kids Church on Sunday mornings, children are released to the individual who presents the child's security tag to the leader of the room. Children grades 3-4 are allowed to dismiss themselves upon approval from the parent/guardian. As it pertains to Next Level, children grades 5-6 are to check themselves in and out of the program with the leader doing checkins. Mount Olive Church is not liable for the whereabouts of the child upon release, or check out.
Offsite Activities

For activities happening outside of Mount Olive Church property.
Do you grant permission for Mount Olive Evangelical Free Church to provide transportation for your child/ward to attend official kids events taking place within 150 km radius of the church building? This includes but is not limited to the cities of Calgary and Red Deer, Alberta. In cases of concern, I understand that at any time I have the means and ability to ask questions, and/or withhold my child/ward from attending any event I choose. (Specific permission is sought for overnight events or trips exceeding 150km)*

YesNo
I/we, the parents or guardians named above, authorize Children's Ministry Director Alexis Goodbrand or one of the Mount Olive Evangelical Free Church Ministry Staff/Volunteer to sign consent for medical assessment, treatment or procedures for the participant named above.

I/we, named above, undertake and agree to indentify and hold blameless Alexis Goodbrand, the Ministry Staff/Volunteers, Mount Olive Evangelical Free Church, its Pastors and Board of Elders from and against any loss, damage, death or injury suffered by the participant as a result of being part of the activities of the Mount Olive Evangelical Free 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 Mount Olive Evangelical Free Church.
Parent/Guardian Signature*
Printed Name*

First NameLast Name
Date Signed*

MonthDayYear
Date
Photos
YesNo
I have read, understood and agree with the above and sign it to cover all Mount Olive Children's Ministry activities for the program year effective from date signed through June 30, 2024.
Parent/Guardian Signature*
Printed Name*

First NameLast Name
Date Signed*

MonthDayYear
Date
Purposes and Intent

Mount Olive Evangelical Free Church is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to assign the child 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 indefinitely as it is a requirement of our insurance company and legal counsel. If you wish Mount Olive Evangelical Free Church to limit the information collected, or to view your child's information, please contact us.
Should be Empty:

Registration and Medical Consent Form

For The 2023-2024 Ministry Year

Pick Up

Offsite Activities

Photos

Purposes and Intent