FLC Youth Ministry Registration Form 2025-2026
PURPOSE AND EXTENT: Fraser Lands Church 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 church. This information will be maintained indefinitely, as it is a requirement of our insurance company and legal counsel. If you wish Fraser Lands Church to limit the information collected, or to view your child’s information, please contact us.
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Child's Information
Name of Child
*
First Name
Middle Name
Last Name
Date Of Birth
*
-
Month
-
Day
Year
Date
Gender
Female
Male
Grade (In September 2025)
*
Please Select
7
8
9
10
11
12
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone
*
-
Area Code
Phone Number
Mobile Phone
-
Area Code
Phone Number
Email
*
example@example.com
Health Card Number
*
Family Doctor's Name
Family Doctor's Phone
-
Area Code
Phone Number
Allergies / Medical Conditions
Does your child have any physical, emotional, mental, behavioural concerns, or limitations that our staff and counsellors should be aware of?
*
Yes
No
If YES, please explain
Is your child bringing any medication with him/her?
*
Yes
No
If YES, please explain
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Parent / Guardian Contact Information
In the case of custody agreements, please include the proper form authorizing parental contacts.
Primary Contact Name
*
First Name
Last Name
Relationship to Child
*
Father
Mother
Guardian
Phone
*
-
Area Code
Phone Number
Email
*
example@example.com
Secondary Contact Name
First Name
Last Name
Relationship To Child
Father
Mother
Guardian
Phone
-
Area Code
Phone Number
Email
example@example.com
Alternate Contact Name
First Name
Last Name
Relationship To Child
Phone Number
-
Area Code
Phone Number
Email
example@example.com
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Youth Ministry Program Registration
*Select all Fraser Lands Church Youth Ministry programs that your child is registering for.
Program
*
Friday Knights - Grade 7-9 Youth Group / Small Groups (Fridays, 7:30pm-9:30pm)
ACTS - Grade 10-12 Youth Group / Small Groups (Fridays, 7:30pm-9:30pm)
Christian Education Class (Sundays, 9:15am-10:15am)
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CONSENT
Please read the consent statements below carefully before choosing to agree.
CONSENT TO MEDICAL TREATMENT
I/we, the parents or guardians named above, authorize Rev. Nathan Sun, or one of the Fraser Lands Church Ministry Staff to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above.
*
I Agree
CONSENT TO LIABILITY RELEASE
I/we, named above undertake and agree to indemnify and hold blameless Rev. Nathan Sun, the Ministry Staff, Fraser Lands Church, its Pastors and Board of Elders from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Fraser Lands Church, as well as of any medical treatment authorized by the supervising individuals representing the church. This consent and authorization is effective only when participating in events of Fraser Lands Church.
*
I Agree
CONSENT TO MEDIA RELEASE
I/we, named above, authorize Fraser Lands Church to use any photographs or video taken of my child while participating in youth programs of Fraser Lands Church. I/we understand that photographs or video of my child may be used in newsletters, printed promotional materials, bulletin boards, annual reports, on the Fraser Lands Church website, and on official Fraser Lands Church social media and consent to such use. Note: photos or video where a person is not identifiable may be used without consent. It is my responsibility as parent or guardian to instruct my child to avoid official ministry cameras if it is my preference that photos and videos of my child be used.
I Agree
CONSENT FOR SOCIAL MEDIA COMMUNICATION
I/we, named above, acknowledge and understand that I/we will have access to everything provided to my child and be made aware of how social media is being used, be told how to access the sites or applications, and be given the opportunity to be copied on all material sent to my child via social networking (including text messages). I/we authorize and consent to the staff and ministry personnel of the Fraser Lands Church to communicate with my child electronically, including via social media, text, email, phone and video conferencing tools in accordance with the program(s). I/we understand that if any staff or ministry personnel knowingly communicate privately with my child as a part of his or her duties for or on behalf of Fraser Lands Church, reasonable steps will be taken to send to me the same communication content, though not necessarily via the same technology. I/we acknowledge that to review or receive public communications shared via social media with my child, I/we will need to become a user of the same social media. I/we understand that communications or posts may be accessible or viewable by others who are also users of the same social media. I/we understand that without this consent my child will not be able to participate in the program(s). If I/we choose to rescind my authorization and consent provided herein, I/we agree that I/we will inform Fraser Lands Church in writing and that my rescission will not take effect until it is acknowledged by Fraser Lands Church. I/we understand, however, that it may not be possible to recall any work, photos or videos that have been published as part of the program(s) prior to receipt of my written rescission.
*
I Agree
CONSENT FOR ELECTRONIC MAILING LIST SUBSCRIPTION
Alternatively you can subscribe directly to FLC Youth Ministry's mailing list and begin receiving weekly tip-offs immediately at fraserlands.ca/ministries/youth
I/we give consent to receive announcements, event invitations, newsletters, and other electronic messages which may contain advertising or promotions regarding Fraser Lands Church and Fraser Lands Youth MInistry. You can unsubscribe at any time by clicking on the unsubscribe link found at the end of any email sent by FLC Youth Ministry. If you have any questions, please contact Fraser Lands Church.
I Agree
E-mail addresses to be added (Please separate emails by a comma)
I HAVE READ THIS CONSENT AND RELEASE FORM AND HAVE HAD THE OPPORTUNITY TO CONSIDER ITS TERMS AND UNDERSTAND THEM. I VERIFY THAT I HAVE READ AND VOLUNTARILY AGREE TO THE TERMS AND CONDITIONS OF THE CONSENT AND RELEASE FORM. I FURTHER HEREBY HOLD HARMLESS, RELEASE AND FOREVER DISCHARGE FRASER LANDS CHURCH AND ITS STAFF, MINISTRY PERSONNEL, AND LEGAL REPRESENTATIVES FROM, AND SHALL INDEMNIFY THEM AGAINST, ALL CLAIMS, DEMANDS, AND CAUSES OF ACTION WHICH I, MY HEIRS, REPRESENTATIVES, EXECUTORS, ADMINISTRATORS OR ANY OTHER PERSON(S) ACTING ON MY BEHALF OR ON BEHALF OF MY ESTATE HAVE OR MAY HAVE BY REASON OF MY CHILD’S PARTICIPATION IN THE PROGRAM(S) AND THROUGH MY AUTHORIZATION, CONSENT AND RELEASE HEREIN. I HAVE READ THIS CONSENT AND RELEASE FORM, I FULLY UNDERSTAND IT, AND I VOLUNTARILY AGREE TO BE BOUND BY ITS TERMS.
*
I Agree
Parent/Guardian Name
*
First Name
Last Name
Signature
*
Submit
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