23-24 Caves Youth Student Ministry Registration

Caves Youth Student Ministry Registration Form

2023-2024
Student Info
Name*

First NameLast Name
Grade*
Gender*
Date of Birth*

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityProvince

Postal Code
Student Cell Number
Please enter a valid phone number.Format: (000) 000-0000.
Student Medical Info*

Health Card Number

Family Doctor Name

AllergiesMedications

Other physical, emotional, mental, or behavioural concerns/limitations we should be aware of?
Parent/Guardian #1*

First Name

Last Name

Cell NumberEmail

Relationship to Student
Parent/Guardian #2

First Name

Last Name

Cell NumberEmail

Relationship to Student
Communication

In order to keep in touch with students, the leadership at Ferndale Youth would like to know which forms of contact you as the parent/guardian are comfortable with us using to speak to your student
Phone Call (home/cell)Text Message/Social Media DMGroup Video Call (Zoom/Instagram)Group Chats (Text, Instagram, Messenger, etc.)
Photos of your student may be used for church promotional material or social media posts*
I would like to be added to the Caves Youth Mailing List (to stay up to date on all the cool things we're doing)
Parent Email for Mailing List
Ferndale Bible Church is obligated to collect and retain this personal information for the purpose of enrolling your student in Jr & Sr High Ministry. This information will be maintained permanently as it is a requirement of our insurance company and legal counsel. We collect this information to develop and nurture ongoing relationships with you and your student, and to inform you of program updates and upcoming opportunities at our church. If you wish Ferndale Bible Church to limit the information collected, or to view your student’s information please contact us.

I/We the parents or guardians named above, authorize the ministry staff of Ferndale Bible Church 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. I/We named below, undertake and agree to indemnify and hold blameless the ministry staff, Ferndale Bible Church, its Pastors and Full Board from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Ferndale Bible 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 travelling on events of Ferndale Bible Church.

I have read, understood and agree with the above and sign it to cover all Youth Ministry activities for the program year effective September 2023 to August 2024, including large group gatherings and small group activities in host homes/parks/public spaces. A separate Informed Letter of Consent will be required for your child/student to participate in activities of elevated risk (trips, retreat, etc).
Name of Parent Giving Permission*
Signature
Date

MonthDayYear
Date
Should be Empty:

Caves Youth Student Ministry Registration Form

Student Info

Communication