Regisration Form For All Child and Youth Programs

CHILD/YOUTH MINISTRY AUTHORIZATION AND MEDICAL CONSENT FORM

Information received is confidential and is being gathered for the purposes of serving your child while in the care of Trumpet Of Truth Christian Ministries. Any medical information collected here serves to authorize Trumpet Of Truth Christian Ministries, and its staff and volunteers, to obtain medical assistance in emergencies. The safety of your child is our primary concern. Precautions will be taken for their wellbeing and protection.
For the school year: example:2023-2024
Student Name
Preferred Nickname
Date of Birth

MonthDayYear
Date
Grade as of September
Mother's (Guardian) Name
Address
Phone #
Cell #
Email
example@example.com
Work #
Father's (Guardian) Name
Address (if different)
Phone #
Cell #
Work #
Child Resides With

Mother OnlyFather OnlyBothOther
In the case of custody agreements, please include the proper form authorizing parental contacts.

Other people authorized to pick up my children from Trumpet Of Truth Christian Ministries:
Health Card Number
Family Doctor
Phone Number
Emergency Contact: Name
Phone
Relationship to Child
The Plan to Protect - Policies and Procedures Manual

Does your child have any allergies:
YesNo
If yes, please list
Does your child have any physical, emotional, mental, behavioural concerns or limitations that our staff should be aware of?
YesNo
If Yes, please explain
Is your child bringing medication with him/her?

YesNo
If Yes, Please list. (If medication needs to be taken while the child is under our care, please specify the dosage and the time it will be given. A medication form will be kept for your child and you will be required to sign this form each day at pick up.)
Please inform us of any other restrictions(dietary or otherwise):
Please sign below to grant permission for the reasonable use of pictures containing your child in any or all of the following ways:

Brochures/Promotional materialChurchWebsiteNewsletters
WAIVER

I/We, the parents or guardians named above, authorize the ministry staff of Trumpet Of Truth Christian Ministries to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above. (If you do not consent to this part of the waiver, you must sign the section below indicating your declination and write the alternative action to be taken*

I/we, named above, undertake and agree to indemnify and hold blameless the Ministry Staff, Trumpet Of Truth Christian Ministries, 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 the Trumpet Of Truth Christian Ministries, as well as of any medical treatment authorized by supervising individuals representing the church. This consent and authorization is effective only when participating in or traveling to events of the Trumpet Of Truth Christian Ministries.
Student Ministry Activities Parent/Guardian Options (choose one of the following options):

1. I have read, understood and agree with the above and sign it to cover all Student Ministry activities for the program year effective as stated below.
Signature

Clear
Printed Name
Date

MonthDayYear
Date
Effective from date signed through to:
2. have read, understood and agree with the above and sign it to cover only the activity listed below.
Activity
Signature

Clear
Printed Name
Date

MonthDayYear
Date
Purposes and Extent:

Trumpet Of Truth Christian Ministries is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to assign the student 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 Trumpet Of Truth Christian Ministries to limit the information collected, or to view your child's information, please contact us.
"If you decline to have one of our ministry staff to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above, please sign below and indicate alternative action to be taken.
Parent/Guardian Signature

Clear
Printed Name
Date

MonthDayYear
Date
Alternative action to be taken
TOTCM Children's / Youth Ministries 194817 19th Line, Ingersoll, ON, NSC 3J6 office@trumpetoftruthministries.com 79
Should be Empty:

"If you decline to have one of our ministry staff to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above, please sign below and indicate alternative action to be taken.