Rooted Registration Form (2022-2023)

Rooted Registration Form

Please fill this out if you are registering a new student or updating student information.
What would you like to do?*

New RegistrationUpdate Student InformationUpdate Parent/Guardian Information
Student Information
Full Name*

First NameLast Name
Home Email*
example@example.com
Home Phone Number*
Please enter a valid phone number.
Home Address*

Home Address Street Line 1

Home Address Street Line 2

Home Address CityHome Address State

Home Address Zip Code
Gender*

MaleFemale
Birthdate*

DayMonthYear
Date
Grade*
Are there any medical concerns we should be aware of*

YESNO
Medical Notes
Parent/Guardian Information
Emergency Contact*

First NameLast Name
Secondary Contact

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Additional Phone Number
Please enter a valid phone number.
Other Email
example@example.com
Informed Consent & Acknowledgement
By submitting this form, I agree to the understanding that a snack may/sometimes be given during program and I agree to the Consent and Acknowledgement below.*

YESNO
Snack Distribution, Consent and Acknowledgement

I/We the parents or guardians named above hereby give my permission to the personnel selected by the Bramalea Baptist Ministry staff to give snack to my child at designated times during program. I/We understand that ALL snacks provided are peanut/ tree nut free and when possible are also dairy, gluten and soy free as well. I/We understand that providing an alternative "Safe Snack" option is the responsibility of the parent/guardians and any provided snacks must be peanut/tree nut free.

In the event I cannot be reached in an emergency, I/We the parents or guardians named above hereby give my permission to the medical personnel selected by the Bramalea Baptist Ministry staff to secure emergency medical treatment including but not limited to, first aid, CPR, admission to any hospital, tests, surgery or general anaesthesia. I/We, named above, undertake and agree to indemnify and hold blameless Bramalea Baptist Church, its Pastors and Board of Directors from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Bramalea Baptist Church. This consent and authorization is effective only when participating in or traveling to/from events of the Bramalea Baptist Church. I/ We understand that electronic devices are not allowed during programs. However pictures may be taken at designated times and events by participants. Photos or videos taken for church purpose/ promotion will never be published with names (unless parental permission is obtained). I/ We understand that the information being collected may be used for mail and electronic communication purposes ONLY by Bramalea Baptist Church. Information will never be given to a third-party.
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Rooted Registration Form

Student Information

Parent/Guardian Information

Informed Consent & Acknowledgement