Nursery, Sunday School, and Youth groups

Registration Form 2024-25

Please fill one per child

Name of Child/Youth

Date of Birth

Date

Age

Place of birth

Allergies

Tell us more about your child so we can minister to them in the best way possible. Please include Medical concerns, Developmental concerns, etc. that we should be aware of (confidential information)

Mother's Name

Father's name

Email address of parents / guardians

Secondary Email address

example@example.com

Phone number of parents/guardians

Format: (000) 000-0000.

Secondary Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Alternative Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergnecy contact name and relationship to the child/ youth

Emergency contact phone number:

Format: (000) 000-0000.

Name of person(s) to pick up the child/youth from Sunday school:

Name

Phone

Format: (000) 000-0000.

Name

Phone

Format: (000) 000-0000.

Name

Phone

Format: (000) 000-0000.

Names of other siblings enrolled in Sunday School

We would like to encourage parents to be involved in their children's christian education and faith formation. Volunteering for two Sundays per year in the classroom will offer the opportunity to get to know what your child does every Sunday at Sunday school, deepen your biblical knowledge and faith, and engage you in a fun experience with the children. Would you be willing and able to volunteer for two Sundays a year in a Sunday classroom?

YesNo

If yes, What's your preferred email address:

example@example.com

Please tell us which Sunday you are available:

Date

Permissions:

1. Medical Permission:

I, the undersigned parent/guardian, do hereby grant permission for my child/youth, named above, to attend Nursery, Sunday School, and youth group ministry of Parkdale United Church. In order that my child/youth may receive the proper medical treatment in the event that my child/youth may sustain injury or illness on Sunday, I hereby authorize the staff and volunteer teachers at Parkdale to obtain or provide medical treatment for my child/youth for such injury or illness and I hereby hold the staff and volunteers at Parkdale Church, as well as its representatives, harmless in the exercise of this authority. I further understand that there is always a possibility that my child/youth may sustain physical illness or injury. If this occurs, I hereby authorize the staff and volunteer teachers to refer my child/youth to a medical treatment center (hospital, etc I further acknowledge and understand that I will be responsible for any medical bills that may be incurred on behalf of my child/youth for physical illness or injury that my child/youth may sustain during the time at Nursery, Sunday School or youth groups.

2. Media Permission:

Please initial below to grant permission for the use of pictures of your child/youth in any or all the following ways: Church newsletter 'The Messenger', Church brochures, emails, website. Please note that we DO NOT use photos for FB or social media and names will not be attached to photos.

Purpose and Extent:

Parkdale United Church is collecting and retaining this personal information only for the purpose of enrolling your child/ youth in our programs, to assign the appropriate classes, to develop and nurture ongoing relationships with you and your child/youth, and to inform you of program updates and upcoming activities at our Church. The collection of this information is a requirement of our insurance company and is kept confidential. It will be shared only when necessary with the staff and teachers who minister to your child/youth. Thank you.

Parent Guardian Signature

Date