Children's Ministry Registration & Consent Form

Children's Ministry Registration & Consent Form

Information received is confidential and is being gathered for the purposes of serving your child while in the care of First Alliance Church: Toronto. Any medical information collected here serves to authorize First Alliance Church: Toronto and it's staff and volunteers to obtain medical assistance in emergencies. This form should be completed annually by the Parent / Guardian.
Child's Name*

First NameLast Name
Nickname
Date of birth*

MonthDayYear
Date
Current grade*
Current grade*
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
List any allergies and if he/she requires and EpiPen.*
Type "No" if there are none
Please list any physical, emotional, mental, behavioural concerns or limitations your child may have that staff should be aware of?*
Type "No" if there are none
If your child bringing any medications with him/her. If so, please list them.*
Type "No" If there are none
Emergency contact name (other than Parent / Guardian)*
We will always attempt to contact Parent / Guardian first.
Emergency contact phone number*
Please enter a valid phone number.
Parent / Guardian 1*

First NameLast Name
Phone number for contact and check-in*
Please enter a valid phone number
Parent / Guardian 2

First NameLast Name
Phone number for contact and check-in
Please enter a valid phone number
Best email for communication*
Additional email (if desired)
Medical Release*

The safety of your child is our primary concern. Precautions will be taken for their well-being and protection. I/we, the Parents or Guardians named below, authorize the Children's Pastor or one of the First Alliance Church: Toronto personnel to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procures for the participant named above in the case of an emergency.
Release of Liability*

I/we named below, undertake and agree to indemnify and hold harmless program personnel, First Alliance Church: Toronto, and it's leaders and Board from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of First Alliance Church: Toronto, as well as any medical treatment authorized by the supervising individuals representing First Alliance Church Toronto. This consent and authorization is effective only when participating in or traveling to events sponsored by First Alliance Church: Toronto.
Photo Release*

From time to time First Alliance Church: Toronto may take pictures, videos, or make sound recordings during it's programming. These photos/videos, without identifying names or tags may appear during other First Alliance Church: Toronto events and/or through First Alliance Church: Toronto media and affiliated accounts (church website, upload sites, social media such as Instagram, Facebook, Twitter, etc.). By enrolling your Child, you are granting permission for your Child to be photographed and/or videotaped at different Children and Youth Programs.
Purpose and Extent*

I understand First Alliance Church: Toronto 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 organization. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish first Alliance Church: Toronto to limit the information collected, or to view your child's information, please contact First Alliance Church: Toronto at office@firstalliancechurch.org.
2 Step Registration

I understand that once I have completed this official registration form I need to sign my child up for individual programs for the year. The confirmation email will direct me to the second step or I can find it at: https://firstalliancechurch.churchcenter.com/registrations/events
Confirmation*

I have read, understood and agree with the above, and by entering my name below, I am delivering an electronic signature that will have the same effect as an original manual paper signature. The electronic signature will be equally as binding as an original manual paper signature.
In case of custody agreements, please provide the proper form authorizing Parental contacts to the Children's Pastor.
Signature Name (Parent / Guardian)*

First NameLast Name
Today's Date*

MonthDayYear
Signature*

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First Alliance Church: Toronto | Plan to Protect® Policy | This policy has been adapted from Plan to Protect®, permission granted by Plan to Protect® 2015© for use by First Alliance Church: Toronto
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