2026-2027 Children's Ministry Registration Form
PURPOSE AND EXTENT: Fraser Lands Church is collecting and retaining this personal information for the purpose of enrolling your child in our programs, assigning your child 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 is retained in accordance with Fraser Lands Church's record keeping practices and the requirements of our insurance provider and legal counsel. If you would like to review your child's information or discuss the information being collected, please contact the Children's Ministry Pastors.
Child's Information
Name of child
*
First Name
Last Name
Preferred Name (if different from legal name)
Gender
*
Male
Female
Date of Birth
*
/
Month
/
Day
Year
Date
Grade in September 2026
*
Nursery: born 2024 or later
3 year old: born 2023
4 year old: born 2022
5 year old: born 2021
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Address Line 1
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City
*
Province
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Please Select
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Postal Code
*
example: V5S 4R8
Email
*
example@example.com
Home Phone
*
-
Area Code example: 604
Phone Number example: 451-5449
Has any of your contact information (address, email, phone) changed since September 2025?
*
Yes
No
Health Information
Information received is confidential and is being gathered for the purposes of serving your child while in the care of Fraser Lands Church. Any medical information collected here serves to authorize Fraser Lands Church, and its staff and volunteers, to obtain medical assistance in emergencies.
Allergies / Medical Conditions (Please write NA if there are no allergies/medical conditions)
*
Is your child bringing any medication with him/her?
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Yes
No
If YES, please list the medication:
Does your child have any physical, emotional, mental, behavioural concerns or limitations that our staff should be aware of?
*
Yes
No
If YES, please explain concerns or limitations:
Parent / Guardian Contact Information
In the case of custody agreements, please include the proper form authorizing parental contacts. ***Please note only parent/guardian can pick-up child upon check out.
Primary Contact Name
*
First Name
Last Name
Relationship to Child
*
Father
Mother
Guardian
Mobile Phone
*
-
Area Code example: 604
Phone Number example: 451-5449
Primary Email
*
example@example.com
Spouse/Alternate Contact Name
First Name
Last Name
Relationship to Child
Father
Mother
Guardian
Spouse/Alternate Mobile Phone
-
Area Code example: 604
Phone Number example: 451-5449
Spouse/Alternate Email
example@example.com
Children's Ministry Sunday Programs
For Sunday mornings, we offer 2 sessions which start at 9:15 am and 11:00 am respectively, for children from Preschool to Grade 6.
Please check the Sunday programs you would like to register your child.
Email Subscription
Subscribe to receive weekly email updates on our Children's Ministry.
Would you like to receive weekly email updates on our FLC Children's Ministry Programs?
*
Yes
No
Would you like weekly email updates to be sent to
*
Primary E-mail only
Both Primary and Spouse/Alternative E-mails
None
Release & Permission Statements
**CONSENT TO MEDICAL TREATMENT** I/we, the parents or guardians named above, authorize one of the Fraser Lands Church Ministry Staff or Volunteers 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
**LIABILITY RELEASE** I/we, named above undertake and agree to indemnify and hold blameless the Ministry Staff and Volunteers of 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.
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I Agree
**MEDIA RELEASE** I/we, named above, authorize Fraser Lands Church to use any photographs or video taken of my child while participating in children's programs of Fraser Lands Church. I/we understand that photographs or video of my child may be used in newsletters, 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.
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I Agree
I understand and acknowledge that when my child participates in the children's programs listed above, they are under supervision when they are checked in to the programs they registered to. Parents will resume responsibilities when your child is checked out. I HAVE READ, UNDERSTOOD AND AGREE WITH ALL THE ABOVE AND SIGN IT TO COVER ALL FRASER LANDS CHURCH CHILDREN'S MINISTRY ACTIVITIES FOR THE CURRENT PROGRAM YEAR.
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I Agree
FRASER LANDS CHURCH CONSENT AND RELEASE FORM FOR CHURCH-SPONSORED VIRTUAL EVENTS AND MINISTRY
AUTHORIZATION, CONSENT AND RELEASE FOR USAGE OF SOCIAL MEDIA AND/OR OTHER ELECTRONIC COMMUNICATION INVOLVING MINORS
1. I, (The parent/guardian named above) acknowledge that I am the parent/guardian of the child(ren) named above and legally represent my child(ren). \ 2. I understand that I will have access to everything provided to my child(ren) 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(ren) via social networking (including text messages). \ 3. I authorize and consent to the staff and ministry personnel of the Fraser Lands Church to communicate with my child(ren) electronically, including via social media, text, email, phone and video conferencing tools in accordance with the program(s). \ 4. I understand that if any staff or ministry personnel knowingly communicate privately with my child(ren) 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 acknowledge that to review or receive public communications shared via social media with my child(ren), I will need to become a user of the same social media. \ 5. I understand that communications or posts may be accessible or viewable by others who are also users of the same social media. I understand that without this consent my child(ren) will not be able to participate in the program(s). If I choose to rescind my authorization and consent provided herein, I agree that I will inform Fraser Lands Church in writing and that my rescission will not take effect until it is acknowledged by Fraser Lands Church. \ 6. I 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 have read this Consent and Release Form and have had the opportunity to consider its terms and understand them. \ 7.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(ren)’s participation in the program(s) and through my authorization, consent and release herein. \ 8. I have read this Consent and Release Form, I fully understand it, and I voluntarily agree to be bound by its terms.
*
I Agree
Signature
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Submit
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