Young Adults 2023/24 Registration Form
Child 1
*
First Name
Last Name
Age
*
Grade
*
Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number (if any)
Please enter a valid phone number.
Email Address (if any)
example@example.com
Health Card # (for emergency hospital trips)
*
Does the child have any allergies?
*
Does the child have any medical conditions that we should be aware of?
*
Child 2
First Name
Last Name
Age
Grade
Date of Birth
-
Month
-
Day
Year
Date
Phone Number (if any)
Please enter a valid phone number.
Email Address (if any)
example@example.com
Health Card # (for emergency hospital trips)
Does the child have any allergies?
Does the child have any medical conditions that we should be aware of?
Child 3
First Name
Last Name
Age
Grade
Date of Birth
-
Month
-
Day
Year
Date
Phone Number (if any)
Please enter a valid phone number.
Email Address (if any)
example@example.com
Health Card # (for emergency hospital trips)
Does the child have any allergies?
Does the child have any medical conditions that we should be aware of?
Address 1 (if same for all children)
Street Address
Street Address Line 2
City
Province
Postal / Zip Code
Address 2 (if different from some children)
Street Address
Street Address Line 2
City
Province
Postal / Zip Code
Parent/Guardian Information
Parent/Guardian 1
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Parent/Guardian 2
First Name
Last Name
Phone Number
Please enter a valid phone number.
Emergency Contact (if parent/guardian is unavailable)
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Participation, Medical Treatment & Liability Waiver
I, the parent or legal guardian, give permission for my child(ren) to attend and participate in the activities within the Young Adults Ministries of Emmanuel Baptist Church, and to receive medical treatment in any case of injury resulting from these activities, especially in the event that I cannot be reached. If necessary, I further give permission for my child to be taken to a licensed phsyician to provide necessary care (including anesthesia), for my child(ren)'s well-being. Thus, I allow my child to ride any vehicle that is injury or activity related, provided that there's at least one leader on board and driving.
I hereby release Emmanuel Baptist Church and any of their staff/volunteer leaders from any and all liability regarding any accident or injury to my child(ren) as a result of participation in the activities within the Young Adults Ministries of Emmanuel Baptist Church.
Parent/Guardian Signature (upon agreement with the liability waiver)
*
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Photo Permission Waiver
I, the legal parent/guardian, give permission for Emmanuel Baptist Church to use photos/videos of my child(ren) while participating in these activities, including social media platforms, video screens, or the church's website, provided that no confidential information that puts my child(ren)'s identity or reputation at risk will be posted.
Parent/Guardian Signature (upon agreement with the photo waiver)
*
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Date Signed
*
-
Month
-
Day
Year
Date
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