IAC Youth Waiver 2025/26

Student's Name*

First NameLast Name

Date of Birth*

Date

Current Grade (2025/26)*

Address*

Street Address

Street Address Line 2

CityProvince

Postal Code

Student's Email Address/Phone Number

Parent('s)/Guardian('s) Name(s)*

Parent('s) Email(s)*

Parent('s) 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.

Provincial Health Card Number (Optional)

Name of Family Doctor

Doctor's Phone Number

Does the student have any 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?

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 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.

Photos

I hereby grant permission to Innisfail Alliance Church, on behalf of my child to photograph or videotape my child; display or reproduce any of my child’s work which is produced during participation in programs for non-profit, educational and/or promotional purposes. I understand the production(s)/work(s) may be shown in newsletters, during regular church events, and other church-related activities at Innisfail Alliance Church or at Innisfail Alliance Church-sponsored displays in the community or used on IAC's website.

Communication Request

As youth leaders, we want to be available to communicate with your youth throughout the week. Due to our child protection policy, we need your permission in order to directly text/message your youth and engage in conversation with them. Accountability and guidelines will be in place to ensure safety on both sides.

For most communication we'll be using an app called "Faithspark" that will allow chats 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 special requests for how leaders are to contact your youth please let Pastor Josiah know.

✅ FAITHSPARK APP. I allow my child to use the FaithSpark app for moderated conversations with the youth ministry leaders of Innisfail Alliance Church.✅ TEXT MESSAGE. I allow my child to text the leaders I list below❌ I do not want my youth communicating with any of the leaders through devices during the week

Names of Youth leaders that can text message my child (Choose from: Josiah, Judson (Jr. high boys) Mark, Mike (Sr. high boys), Naomi (Gr. 11-12 girls), Dante (Gr. 9-10 girls), Cindy (Gr. 8 girls), Alicia (Gr. 7 girls)

Parent/Guardian Signature*

Date Signed*

Effective from date signed through August 31, 2026

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.

IAC Youth Waiver 2025/26

Student's Information

Parent/Guardian Information

Health Information

Acknowledgment