IAC Children's Waiver 2024/25

IAC Children's Ministry Waiver
Child's Information
Child's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Current Grade (2024/25)*
* If Kindergarten or pre-school put 0
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Parent/Guardian Information
Parent('s)/Legal Guardian('s) Name(s)*
Parent('s) Email(s)*
Parent('s) Phone Number(s)*
Home Phone Number
Please enter a valid phone number.
Emergency Contact (Other than Parent/Guardian)*

First NameLast Name
Emergency Contact's Relationship to Child*
Emergency Contact Phone Number*
Please enter a valid phone number.
Health Information
Provincial Health Card Number*
Name of Family Doctor & Phone Number
Does the child 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?
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 Pastor Dave Wiebe or one of the Innisfail Alliance Church Ministry Personnel to sign consent for emergency medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above.
- I/we, named below, undertake and agree to indemnify and hold blameless Ministry Personnel, 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 or social media.
YesNo
Parent/Guardian Signature*

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Date Signed*

MonthDayYear
Effective from date signed through August 31, 2025.
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 Children's Ministry Waiver

Child's Information

Parent/Guardian Information

Health Information

Acknowledgment