JESUS' LOVE FROM ABOVE❤️ONE DAY FUN DAY

90 - 4th Street, Box 35 Lac du Bonnet, MB ROE 1A0
Phone 204-345-2934 Email: general@abundantlifechapel.ca
Website: abundantlifechapel.ca
JESUS' LOVE FROM ABOVE❤️ONE DAY FUN DAY
August 15, 10:30am - 3:15pm For Kids ages 5-11 (Entering Grades K-6). Lunch, Snacks, Games, Crafts, Songs, Stories & FUN! All for FREE!
If you have more than 1 child going fill out a form for each child. Information received is confidential and is being gathered for the purposes of serving your child while in the care of Abundant Life Chapel. Any medical information collected here serves to authorize Abundant Life Chapel, and its staff and volunteers, to obtain medical assistance in emergencies.
Student Name
Address
Phone Number
Format: (000) 000-0000.
Date of Birth

MonthDayYear
Date
Phone Home
Format: (000) 000-0000.
Mother's /Guardian's Name
Email
example@example.com
Cell Number
Format: (000) 000-0000.
Address (if different from above)
Father's /Guardian's Name
Phone Home
Format: (000) 000-0000.
Email
example@example.com
Cell Number
Format: (000) 000-0000.
Address (if different from above)
**In case of custody agreements, please explain to Staff at Registration table**
Manitoba Heath # (6 digits)
PHIN (9 digits)
Family Doctor
Phone
Format: (000) 000-0000.
Allergies
Does your child have any physical, emotional, mental, behavioural concerns or limitations that our staff should be aware of?
if yes, please explain
Emergency Contact
In case of emergency, every effort will be made to contact the parent/legal guardian named above. Please provide an alternate emergency contact in the event we are unable to do so.
Name
Phone #
Format: (000) 000-0000.

Relationship to Child
I agree that I am the parent/legal guardian of the above named child. By signing, I agree that all information listed above is true and accurate. I agree that I will notify Abundant Life Chapel of any changes pertaining to the above named child. I named below undertake and agree to indemnify and hold blameless Abundant Life Chapel Fun Day Staff & Volunteers, Pastor and Board of Deacons from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Abundant Life Chapel as well as of medical treatment authorized by supervising individuals representing the church. This consent and authorization is effective only when participating in events (ONE DAY FUN DAY) of Abundant Life Chapel.
Print Name
Date

MonthDayYear
Date
Signature
PLEASE FILL OUT THE INFORMATION BELOW IF SOMEONE OTHER THAN THE PARENT/ LEGAL GUARDIAN WILL BE BRINGING/PICKING UP YOUR CHILD(REN) TO One Day Fun Day.
I,
hereby give
permission to sign my child(ren) in and out of One Day Fun Day.
Signature
PLEASE NOTE - IF YOU DO NOT WANT YOUR CHILD(REN) PHOTOGRAPHED - DO NOT SIGN!
I hereby ALLOW my child to be photographed for the private use only of the One Day Fun Day program at Abundant Life Chapel.
Childs Name:
Parents Signature:
I hereby ALLOW my child to be photographed for publication by name in the local paper, The Clipper.
Childs Name:
Parent's Signature:
Should be Empty:

JESUS' LOVE FROM ABOVE❤️ONE DAY FUN DAY

PLEASE FILL OUT THE INFORMATION BELOW IF SOMEONE OTHER THAN THE PARENT/ LEGAL GUARDIAN WILL BE BRINGING/PICKING UP YOUR CHILD(REN) TO One Day Fun Day.

PLEASE NOTE - IF YOU DO NOT WANT YOUR CHILD(REN) PHOTOGRAPHED - DO NOT SIGN!