Youth Registration Form for 2024-2025

Sr High Registration & Consent Form 2025/26
Our Senior High program is designed for high school students in grade 9-12. The regular weekly program meets every Thursday night from 7:00-9:00 pm. Students are given opportunities to connect with each other through fun games, and a small group study.

The program provides a safe environment where students can participate in leader-led bible studies, ask questions and explore issues that affect them personally.
Student Information
Student Information*
Students Email (optional)
example@example.com
Students Cell Phone (optional)

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry
Do you give permission for your student's youth leader to directly text/call your child (there will always be at least two leaders and one student in a group)*

Yes, I grant permissionNo, I do NOT grant permission
Do youth leaders have permission to contact your student(s) on social media in a group chat? (For example, there's an Instagram group chat)*

Yes, I grant permissionNo, I do NOT grant permission
Do you grant permission for one on one mentoring of your student(s) by a youth leader? (Done in a public place such as a coffee shop)*

Yes, I grant permissionNo, I do NOT grant permission
Do you give consent for your student's picture to be used on Facebook/instagram/website or any form of advertising?*

Yes, I grant permissionNo, I do NOT grant permission
Would you like to be added to the youth email list?*

I am already on the email listI would like to be added to the email listI would not like to be added to the email list
Medical Information
Information received is confidential and is being gathered for the purposes of serving your child while in the care of BAC. Any medical information collected here serves to authorize BAC, and its staff and volunteers, to obtain medical assistance in emergencies.
I/We give consent for the Ministry Personnel of Bramalea Alliance Church to administer the following in the event of a medical emergency (answer no if your child does not carry these medications):*
Does Your Student Have Any Allergies, Medical or Behavioural Concerns (If multiple students on the form please specify which student)
Parent/Guardian Name(s)*

First NameLast Name
Email*
example@example.com
Cell Phone #*

Area CodePhone Number
Parent/Guardian Name(s)

First NameLast Name
Email
example@example.com
Cell Phone #

Area CodePhone Number
Emergency contact if parent(s)/guardian cannot be reached*

First NameLast Name
Cell Phone #*

Area CodePhone Number
Purposes and Extent for collecting personal information:

Bramalea Alliance Church is collecting and retaining this personal information for the purpose of enrolling your child in our program, 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 church. This information will be maintained permanently as it is a requirement of our insurance company and legal counsel. If you wish Bramalea Alliance Church to limit the information collected, or to view your child's information, please contact us.
Release and Permission of Parent/Guardian:
Signature of Parent/Guardian*

Clear
Should be Empty:

Sr High Registration & Consent Form 2025/26

Student Information

Medical Information

Purposes and Extent for collecting personal information:

Release and Permission of Parent/Guardian: