Youth Information Form 2024/2025

Youth Information Form 2024/2025

Spruce Grove Alliance Church

This form must be completed for every Youth who intends to attend a Youth Event at or held by SGAC during the 2024/2025 ministry year. It provides important personal information and needs to be completed once per year to cover all youth events during the year. If any of this information changes during the year, please submit another form with the updated information. Thank-you.

FAMILY INFORMATION

Parent/Family E-mail

First Parent/Guardian Name*

First NameLast Name

First Parent/Guardian Phone Number*

Area CodePhone Number

Home/Family Phone*

Area CodePhone Number

Home Mailing Address*

Street Address

Street Address Line 2

City

Postal / Zip Code

Is SGAC your home church?

YesNo

Do you attend another church?

YesNo

Second Parent/Guardian Name

First NameLast Name

Second Parent/Guardian Phone Number

Area CodePhone Number

Second Parent/Guardian E-mail

example@example.com

Are you a member of our Facebook group 'SGAC YOUTH"'?

YesNo (If 'No', please search for it and request to join!)

STUDENT #1 INFORMATION

Youth 1 Name*

First NameLast Name

Youth Cell Phone

Area CodePhone Number

Youth E-mail*

Youth Birth Date*

MonthDayYear

Alberta Health Care Number*

Gender*

MaleFemale

Grade (as of Sept 2024)*

Name of School

STUDENT #2 INFORMATION

Youth 2 Name

First NameLast Name

Youth Cell Phone

Area CodePhone Number

Youth E-mail

example@example.com

Youth Birth Date

MonthDayYear

Alberta Health Care Number

Gender

MaleFemale

Grade (as of Sept 2024)

Name of School

STUDENT #3 INFORMATION

Youth 3 Name

First NameLast Name

Youth Cell Phone

Area CodePhone Number

Youth E-mail

example@example.com

Youth Birth Date

MonthDayYear

Alberta Health Care Number

Gender

MaleFemale

Grade (as of Sept 2024)

Name of School

STUDENT #4 INFORMATION

Youth 4 Name

First NameLast Name

Youth Cell Phone

Area CodePhone Number

Youth E-mail

example@example.com

Youth Birth Date

MonthDayYear

Alberta Health Care Number

Gender

MaleFemale

Grade (as of Sept 2024)

Name of School

EMERGENCY CONTACT & HEALTH INFORMATION

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

Name of Physician

Does any above student have any allergies, chronic illness, or medical conditions?*

YesNo

Please describe, including the severity. (please specify Youth's Name if registering multiple youth) *

Write N/A if there are no issues for any Youth in your household

Is any student listed above on Medication?*

YesNo

Please describe, including whether student requires assistance. (please specify Youth's Name if registering multiple youth)

Please explain any other physical, behavioral, emotional, or mental concerns or limitations that we should be aware of. (please specify Youth's Name if registering multiple Youth)*

Write N/A if there are no issues for any Youth in your household.

CONSENTS

Medical Consent

In the event of an emergency and medical treatment is required, I give permission to the church staff and/or sponsors to obtain services for treatment as deemed necessary if I cannot be contacted in a reasonable amount of time. Further, I will hold harmless or indemnify Spruce Grove Alliance Church for any loss or injury that may be sustained. I recognize that there are risks inherent in activities my youth may be engaged in and again I waive, hold harmless, or indemnify Spruce Grove Alliance Church, paid or volunteer staff, successors, heirs and assigns from any action. Valid from July 1, 2024 to August 31, 2025.

I have read and agree with the Medical Consent.*

YesNo

Photo Waiver

I hereby give permission for my youth to be photographed and/or filmed without any reimbursement of any kind due to me, or the need to pay any fee. Spruce Grove Alliance Church considers all information to be personal and confidential, and will only use it within the church for ministry or other church-related activities, on the website, in print and on our private Facebook group. We will not release photos to outside parties or organizations. Valid July 1, 2024 to August 31, 2025.

I have read and agree with the Photo Waiver.*

YesNo

Off-Site & Overnight Permission

I hereby give permission for my youth to participate in off-site and overnight events between July 1, 2024 and August 31, 2025. I give authorization for representatives of Spruce Grove Alliance Church to obtain necessary medical treatment as needed while off-site. I assume responsibility for any medical bills incurred, and should my youth be required to return home before the group for medical or disciplinary reasons, I also hereby assume any costs incurred. I give authorization for representatives of Spruce Grove Alliance Church to provide all necessary food, transportation, and lodging, as applicable. I do hereby release, forever discharge and agree to hold harmless Spruce Grove Alliance Church and the representatives thereof from any and all liability claims or demands for personal injury, sickness, or death, as well as property damage and expenses of any nature, which may be incurred by my youth in the course of participation in off-site activities. Furthermore, I agree to assume all responsibility for any of the previously mentioned occurrences.

I have read and agree with the Off-Site & Overnight Permission.*

YesNo

Transportation Waiver

Knowing that all precautions have been taken for the safety and health of my youth, some activities including transportation carry with them the inherent risk of personal injury; I/we give permission for my youth to be transported in a motor vehicle driven by the youth leaders to any/all youth events of July 1, 2024 to August 31, 2025. I/we understand that my youth is required to follow all applicable laws regarding riding in a motor vehicle and is to follow all rules set out by the drivers of the vehicles. I/we will not hold SGAC, staff, or volunteers responsible and do indemnify them of any loss, damage or injury suffered by the participant.

I have read and agree with the Transportation Waiver.*

YesNo

I would like to opt-in to receive youth email updates (Please select all that apply)

After completing this form, please click Submit Form. You will receive a confirmation email. If you do not receive the email within a few minutes, please check your spam; otherwise, please contact us at the church office at 780-962-4700.