Immanuel BJJ Registration (Ages 11-15)
Fall 2026 session, starting Sunday Oct 4, 2026, from 1:40 - 2:25pm
Child's Name
*
First Name
Last Name
Child's Birth Date
*
Please select a month
January
February
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April
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December
Month
Please select a day
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Day
Please select a year
2020
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Year
Child's Gender
Please Select
Male
Female
N/A
Child's Health Card Number
Parent / Guardian Name
*
First Name
Last Name
Email
*
example@example.com
Parent / Guardian Phone Number
*
Format: (000) 000-0000.
Alternate Emergency Contact Name & Phone Number
Does your child have any medical, physical, emotional or behavioural concerns or limitations that our Leaders should be aware of? Does your child have any allergies? If yes, please describe below:
We occasionally take videos and photographs of our programs for promotional purposes. Do you consent to having your child's photo used on our social media platforms, website, and/or print media?
*
Yes
No
Would you like to receive email updates about Immanuel Church and Kids Events?
*
Yes
No
Are you currently attending a church? If yes, please specify which one:
*
I understand that Immanuel Baptist Church makes every effort to maintain a healthy and safe environment. However, I know there are still risks associated with attending group activities, and sometimes unforeseen circumstances. I will not hold Immanuel, its staff or volunteers, responsible in the event my child experiences sickness or injury as a result of participating in the Immanuel BJJ program.
By typing your name below, you acknowledge that you are a legal Parent/Guardian of the Child and that, to the best of your knowledge, the information you have entered is accurate.
*
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