IAC Youth Waiver 2026/27

IAC Youth Waiver 2026/27
Parent/Guardian Information
Parent('s)/Legal Guardian('s) Name(s)
Address

Street Address

Street Address Line 2

CityProvince

Postal Code
Parent('s) Email(s)
Parent('s) Cell Phone Number(s)
Emergency Contact (OTHER THAN PARENT/GUARDIAN)

First NameLast Name
Emergency Contact's Relationship to Student
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Student 1 Information
Student's Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Current Grade (2026/27)
Student's Email Address/Phone Number
Health Information
Provincial Health Card Number (Optional)
Name of Family Doctor & Phone Number
Does the student have any allergies?
If yes, please list their allergies:
Other Health Concerns (hearing aids, other aids, etc)
Is your child bringing any medication with him/her? If yes, please list:
Does your child have any physical, emotional, mental, behavioural concerns or limitations that our staff should be aware of?
Do you have a second child to register?

Student 2 Information
Student's Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Current Grade (2026/27)
Student's Email Address/Phone Number
Health Information
Provincial Health Card Number (Optional)
Name of Family Doctor & Phone Number
Does the student have any allergies?
If yes, please list their allergies:
Other Health Concerns (hearing aids, other aids, etc)
Is your child bringing any medication with him/her? If yes, please list:
Does your child have any physical, emotional, mental, behavioural concerns or limitations that our staff should be aware of?
Do you have a third child to register?

Student 3 Information
Student's Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Current Grade (2026/27)
Student's Email Address/Phone Number
Health Information
Provincial Health Card Number (Optional)
Name of Family Doctor & Phone Number
Does the student have any allergies?
If yes, please list their allergies:
Other Health Concerns (hearing aids, other aids, etc)
Is your child bringing any medication with him/her? If yes, please list:
Does your child have any physical, emotional, mental, behavioural concerns or limitations that our staff should be aware of?
Do you have a fourth child to register?

Student 4 Information
Student's Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Current Grade (2026/27)
Student's Email Address/Phone Number
Health Information
Provincial Health Card Number (Optional)
Name of Family Doctor & Phone Number
Does the student have any allergies?
If yes, please list their allergies:
Other Health Concerns (hearing aids, other aids, etc)
Is your child bringing any medication with him/her? If yes, please list:
Does your child have any physical, emotional, mental, behavioural concerns or limitations that our staff should be aware of?

Acknowledgment
The safety of your child is our primary concern. Precautions will be taken for his/her wellbeing and protection.
- I/We, the parents or guardians named below, authorize the ministry staff or personnel of Innisfail Alliance Church to sign a consent for emergency medical treatment and to authorize any physician or hospital to provide emergency medical assessment, treatment or procedures for the participant named above.
- I/We, named below, undertake and agree to indemnify and hold blameless the ministry staff, Innisfail 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 the Innisfail 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 the Innisfail Alliance Church.
Photo/Video Request

During youth programs, Innisfail Alliance Church may take photographs or video for ministry, communication, and promotional purposes.

Please select the level of permission you give for your child(ren):
We will make reasonable efforts to ensure youth without photo/video permission are not intentionally photographed or included in identifiable images used by the church.
Communication Permission

As youth leaders, we want to be available to communicate with your child(ren) throughout the week. Due to our Child Protection Policy, we require parent/guardian permission before leaders communicate directly with youth through messaging. Accountability and guidelines will be in place to ensure safety on both sides.
- Most communication will take place through Twelve, an app that allows conversations between leaders and youth to be moderated by Pastor Josiah.
- Parents may request copies of communication at any time by contacting Pastor Josiah.
- Youth are always encouraged to share any messages with their parents.
*If you have specific instructions regarding how leaders are to contact your child(ren) please let Pastor Josiah know.
Names of Youth leaders that can text message my child
Parent/Guardian Signature
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearEffective from date signed through August 31, 2027
Purpose and Extent: Innisfail Alliance Church 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 Innisfail Alliance Church to limit the information collected, or to view your child’s information, please contact us.
Should be Empty:

IAC Youth Waiver 2026/27

Parent/Guardian Information

Student 1 Information

Health Information

Student 2 Information

Health Information

Student 3 Information

Health Information

Student 4 Information

Health Information

Acknowledgment