Bethel Youth Registration Form: April 2026

Bethel Youth Registration Form: April 2026

Fill out this form carefully for registration.
Student Information
Student's Name

First NameLast Name
Current school grade
As of April 2026
Birth Date

MonthDayYear
Student's MCP Card Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Parent/Guardian Name

First NameLast Name
Parent/Guardian Name

First NameLast Name
Parent/Guardian Email (1)
Parent/Guardian Email (2)
Contact Number (1)
Format: (000) 000-0000.
Contact Number (2)
Format: (000) 000-0000.
Emergency Contact Information
Emergency Contact Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Alternate Phone Number
Format: (000) 000-0000.
Please list ANYONE authorized to pick up your child from Bethel Youth and their phone number. Please note, due to protection policies, we can only release children to those listed here.
Does your child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Are there any medications your child will be bringing with them? If yes, please explain any instructions.
Does your child have any behavioural, developmental or emotional needs we should know about?
Informed Consent and Acknowledgement
I/we hereby consent to the participation of my/our child (the "Participant") in all supervised activities organized by Bethel Bay Roberts, including off-site events and transportation. While every reasonable precaution is taken to ensure the safety and well-being of all participants, I/we understand that certain activities, including sports and recreational events, carry an inherent risk of personal injury. I/we acknowledge and accept these risks and consent to my/our child’s participation.

In the event that my/our child becomes ill or injured and I/we, the parents or guardians listed above, are unable to be reached, I/we authorize the Pastor or a designated representative of Bethel Bay Roberts to seek and obtain medical treatment as deemed necessary. I/we further authorize any licensed physician or hospital to provide medical assessment, treatment, or procedures for my/our child.

I/we agree to indemnify and hold harmless Bethel Bay Roberts, Pentecostal Assemblies of Newfoundland and Labrador, its staff, leaders, volunteers, and board members from any claims, losses, damages, or injuries arising from my/our child’s participation in activities or travel associated with Bethel Bay Roberts, as well as any medical treatment authorized by supervising representatives of Bethel Bay Roberts, except in cases of gross negligence. This consent and authorization is valid for all activities and related travel for a period of one (1) year from the date of signing.
I give permission for photos of my child to be used in promotional material.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME LEGAL EFFECT AS AN ORIGINAL HANDWRITTEN SIGNATURE. I/WE AGREE THAT THIS SIGNATURE IS BINDING AND APPLIES TO ALL PARENTS/GUARDIANS LISTED ABOVE.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Should be Empty:

Bethel Youth Registration Form: April 2026

Student Information

Parent/Guardian Information

Emergency Contact Information

Informed Consent and Acknowledgement

Confirmation