Evergreeen Registration Form 2025 Fillable

Evergreen Heights Christian Fellowship

140 Oak St Simcoe ON N3Y 5M5 519-428-0960

Child and Youth Registration Form

Information received is confidential and is being gathered for the purposes of serving your child while in the care of Evergreen Heights Christian Fellowship. Any medical information collected here serves to authorize Evergreen Heights Christian Fellowship and its staff and volunteers to obtain medical assistance in emergencies.
Childs Name
Age
Grade
Date of Birth YYYYMMDD

MonthDayYear
Date
Childs Name
Age
Grade
Date of Birth YYYYMMDD

MonthDayYear
Date
Childs Name
Age
Grade
Date of Birth YYYYMMDD

MonthDayYear
Date
Address
Parent/Guardian Names
Parent Cell
Please enter a valid phone number.
Parent Work Number
Please enter a valid phone number.
Parent Email
example@example.com
In case of an emergency contact
Phone Number for Emergency Contact
Relationship to Child
List any allergies and to which child they belong:
Does your child have any physical, emotional, mental, behavioural concerns or limitations that our staff should be aware of?

YesNo
If yes, please explain here or request a time to meet with Amanda to discuss further
Is your Child Bringing Medication with him/her?

YesNo
If yes, please list
The safety of your child is our primary concern. Precautions will be taken for their wellbeing and protection I/we, the parents or guardians named above, authorize the ministry staff and volunteers of Evergreen Heights Christian Fellowship Ministry 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/we, named above, undertake and agree to indemnify and hold blameless the ministry staff, Evergreen Heights Christian Fellowship, 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 Evergreen Heights Christian Fellowship, 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 or traveling to events of Evergreen Heights Christian Fellowship

©License Winning Kids Inc. Permission granted to reproduce for local church use only
Parent Signature

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Printed Name
Date

MonthDayYear
Date
Please sign below to grant permission for the reasonable use of pictures containing your child in any or all of the following ways:

Promotional MaterialChurchWebsiteAGM Booklet (digital version is online)Online Services (if children do presentations from the stage)
Parent Signature

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Printed Name
Date

MonthDayYear
Date
Please fill in for students attending Jr. Youth or Sr. Youth programs

A policy is in effect that communication is to be used solely for the dissemination of information. Please sign below to grant permission for Youth Program staff and volunteers to communicate with your student via:
Text MessagingTelephoneEmail
Student Cell
Student Email Address
example@example.com
May your student leave events unattended?

YesNo
I give my child permission to attend Youth events that are offsite (not on church property) that are hosted by Church approved Youth Group Leaders during 2025/2026:

YesNo
Parent Signature

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Date

MonthDayYear
Date
Complete for Children older than 7 Years: I give permission for my child who is 7 years old or older, to leave Sunday School and find me on their own after the service without verification of child and parent/guardian security numbers. I understand that I take full responsibility for my child when service ends. I want my child added to the list kept in each room of children permitted to leave on their own.

Yes
I do not give permission for my child who is 7 years old or older to leave on their own, I will continue to pick them up.

Yes
Child and Youth Ministry Activities

I have read, understood and agree with the above and sign it to cover all Children's Ministry/Youth Ministry activities for September 2025-September 2026.
Signature

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Printed Name
Date

MonthDayYear
Date
Purposes and Extent

Evergreen Heights Christian Fellowship 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 Evergreen Heights Christian Fellowship to limit the information collected, or to view your child's information, please contact us.

©License Winning Kids Inc. Permission granted to reproduce for local church use only
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