IMAC Registration Form 2025-2026

JTK IMAC Applicant Registration Form

To register, child must be in Junior Kindergarten (Grade: JK-Gr.12 (4 to 17 Years Old)
Applicant Name*

First NameLast Name
Gender*

FemaleMale
Date of Birth*

MonthDayYear
Date
School Grade (2025-2026)*
Belong to Jesus The King Melkite Catholic Church Parish:*

YesNo
Allergies / Medical conditions
Parent / Guardian Name*

First NameLast Name
Relationship to applicant *
Parent / Guardian Phone Number*

Area CodePhone Number
Parent / Guardian Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent / Guardian Name 2*

First NameLast Name
Relationship to applicant *
Parent / Guardian Phone Number*

Area CodePhone Number
Parent / Guardian Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact
Emergency Contact Name*

First NameLast Name
Mobile Number*

Area CodePhone Number
Home Phone Number

Area CodePhone Number
Email*
example@example.com

Consent
Do we have permission to photograph/film your child to post in the classroom, JTK Websites and other online applications as it relates to IMAC/MIDADE activities:

YesNo
Parental/Guardian Permission for Emergency Treatment

In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child, and I give consent for the facility to secure any and all necessary emergency medical care for my child.
Release of Liability:
By signing this I*

First NameLast Name
hereby release Jesus the King Melkite Catholic Church, its priests, staff and volunteers from any claims for any damage, loss or injury, of any kind or nature, which may be sustained by participating in this event. This release extends and applies to, and also covers and includes, all unknown, unforeseen, unanticipated and unsuspected injuries, damages, losses and liability and the consequences thereof. I agree, on behalf of all participants in this event, to indemnify the church members from any claims and demands for any damage, loss or injury of any kind or nature which may be sustained by participating in this event. I understand that neither the church nor its priests and members are personally responsible for any damage or bodily harm that may arise during this event. I understand that the applicant’s participation in the program may be terminated at the discretion of Jesus the King Melkite Catholic Church.

In addition, this release extends and applies to, and also covers and includes the use of online learning platforms.

I am waiving any rights to pursue legal action against the above-mentioned parties.
Signature*

Clear
Date*

MonthDayYear
Date

My Products*

IMAC Registration Year 2024 - 2025

$70.00CAD Quantity

Total

$0.00CAD

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

JTK IMAC Applicant Registration Form

Emergency Contact

Consent