Fall Mentorship Cohort 2026 Registration

Fall Mentorship Cohort 2026

Gr 3-5s | Mondays 3:30pm-5:30pm | Kerrisdale Presbyterian Church | Sep 14-Dec 14
CHILD 1 INFORMATION:
Child Name

First NameLast Name
Birth Date

MonthDayYear
Age
Name of School
CHILD 2 INFORMATION:
Child Name

First NameLast Name
Birth Date

MonthDayYear
Age
Name of School
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Registration:

Our weekly Small Group Mentorship is designed for kids grade 3-5 to grow in confidence, character, and life skills in a safe and supportive community. Through engaging discussions, interactive activities, and consistent guidance from adult and youth mentors, kids will learn how to process challenges, build resilience, and develop strong peer connections.
I am registering my child(ren) for
MEDICAL INFORMATION
Medical & Special Needs Information. Does your child(ren) have any allergies, medical condition, physical, emotional, mental, behavioural concerns or limitations that mentors should be aware of?
Emergency Contact:

First NameLast Name
Phone Number of Emergency Contact
Please enter a valid phone number.Format: (000) 000-0000.
Photo & Media Consent
Do you give permission for GodZeala Kids to photograph or record your child during the program activities and use these images for any or all of the following ways: Promotional Material, Website, Videotaping, or Newsletters?
Liability Waiver, Emergency Medical Consent & Privacy & Data Protection
Liability Waiver: I acknowledge that my child’s participation in the GodZeala Mentorship Program involves activities such as games, group discussions, creative projects, and light physical movement. I understand that reasonable precautions are taken by The Born Again Story Ltd., its staff, and volunteers to ensure the safety and well-being of all participants.

By signing below, I:
- Recognize that participation involves inherent risks, including minor injuries or unforeseen incidents.
- Agree to release, waive, and hold harmless The Born Again Story Ltd. (operating as GodZeala), its directors, employees, contractors, and volunteers from any and all liability, claims, or demands arising from my child’s participation in the program, except in cases of gross negligence or intentional misconduct.
- Acknowledge that this release applies to all sessions, events, and related activities organized by GodZeala.
Emergency Medical Consent: In the event of an accident, illness, or medical emergency involving my child, I authorize GodZeala staff to:
- Administer basic first aid as needed.
- Obtain emergency medical treatment for my child if I or my designated emergency contact cannot be reached.
- Share necessary medical information with paramedics or medical personnel.
  
  I understand that every effort will be made to contact me prior to obtaining emergency care. I assume full responsibility for any medical expenses that may result from such treatment.
Privacy & Data Protection: GodZeala, operated by The Born Again Story Ltd., respects your family’s privacy. Personal information collected through registration is used only for program administration, communication, and child safety. Access to data is limited to authorized staff and stored securely. Information will not be shared, sold, or distributed to third parties except when required by law or in a medical emergency. All records are kept confidential and retained only as necessary for program and legal purposes.

Parent/ Guardian Acknowledgement: By submitting below, I confirm that I have read and understood this Liability Waiver, Emergency Consent Form, Privacy & Data Protection and that all information provided is accurate to the best of my knowledge. I voluntarily consent to my child’s participation under these terms.
Payments & Registration Policies
Payment Policies:
- Spots are limited — your child’s place is confirmed once payment is received.
- Missed classes may be made up at another location within the same month (subject to availability). Make-ups cannot be carried forward to the next term.
- Consistent attendance is important. If a child is frequently late or shows low commitment, we may release the spot to another child on the waitlist.
Refund Policy
- Refunds requested before the cohort start date are eligible, minus a $25 administrative fee
- No refunds once the cohort has started
- Refund requests must be submitted in writing to hello@godzeala.ca
- Approved refunds will be processed within 10 business days via [e-transfer / original payment method]
Which payment option would you like to choose? A confirmation invoice/receipt will be sent to your email.
Should be Empty:

Fall Mentorship Cohort 2026

CHILD 1 INFORMATION:

CHILD 2 INFORMATION:

PARENT/GUARDIAN INFORMATION:

Registration:

MEDICAL INFORMATION

Photo & Media Consent

Liability Waiver, Emergency Medical Consent & Privacy & Data Protection

Payments & Registration Policies