BAC Youth Registration

BAC Youth Registration & Consent Form
Information received is confidential and is being gathered for the purposes of serving your child while in the care of BAC. Any medical information collected here serves to authorize BAC, and its staff and volunteers, to obtain medical assistance in emergencies.
Students Name*

First NameLast Name
Birthday*

DayMonthYear
Date
Grade in September*
Health Card #*
Student Cell Phone (leave blank if none)

Area CodePhone Number
Student Cell Phone
(Not Required. By giving this number you're giving permission for youth leaders to text and/or call your student)
Student's Email
(Not Required. By giving this number you're giving permission for youth leaders to contact your student by email)
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Allergies, Medical or Behavioural Concerns*
Photos and/or videos of your student may be taken during the program and/or events outside of the church. Students will not be labeled or identified with their names in any resulting posts. If this is an issue please let our ministry team know.
Parent Contact Information
Parent/Guardian's Name(s)*

First Name of BOTH parents/guardiansLast Name
Parent/Guardian Phone Number (choose the best number to contact you in an emergency)*

Area CodePhone Number
In the event of an emergency and I can't reach you at the number(s) listed above, who is another person we could contact (include name and phone number)? *
Parent's Email*
YesNo
YesNo
I, the parent or guardian named above, authorize Youth Leaders or one of the Pastoral Church Ministry Staff to sign a consent form for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above. I, named above, undertake and agree to indemnify and hold blameless the Ministry Staff, of Bramalea Alliance Church, its Pastors and Board of Elders from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Bramalea Alliance 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 Bramalea Alliance Church.
Signature*

Clear
Should be Empty:

BAC Youth Registration & Consent Form

Parent Contact Information