Dawson Creek Alliance Church / Get Involved / Form

Register for Kids Zone

Child's First Name

Child's Last Name

Child's Gender

Male

Female

Child's date of Birth

Grade

Mother's Name

Father's Name

Guardian's Name

Sibling's name(s)

Emergency Contact name and number

The following people (other then parents) are allowed to sign in/out your child

Your contact info:

Email Address

Phone Number

What is the best way to reach you?

Phone

Please enter your full address:

Street Address

City

Province

Postal Code

Medical Information

Allergies

Does your Child have any physical, emotional, menta, behavioural concerns or limitations that our staff should be aware of?

Yes

if yes, please explain

Does your child have any medical needs that we need to be aware of?

Yes

If yes, please explain

Do you allow our ministry staff to provide your child with a snack?

Yes

The saftey of your child is our primary concern. Precautions will be taken for their wellbeing and protection

Photos

I give Dawson Creek Alliance Church permission to use pictures of my child in the following ways: (Uncheck items for which you do not give permission)

Brochures/Promotional materal

Website

Church Displays

Newsletters

Ministry Activity Permission

I, the undersigned Parents/Guardians, voluntarily grant permission for my child to participate in Dawson Creek Alliance Church children's activities and programs. By voluntarily allowing praticipation, I understand that I am exposing my child to inherent risks and hazards. I agree to accept all risks and hazards and be responsible for any injury or other loss which may occur during the participation of my child. I undertake and agree to indemnify and hold blameless the Ministry staff, Dawson Creek Alliance Church, its Pastors and Board of Elders from and against any loss, damage or injury suffered by my child as a result of being part of the activities of Dawson Creek Alliance Church.

Signed (by typing your first and last name you are agreeing to the above statement)

Purposes and Extent

Dawson Creek Alliance Church 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 insurence company and legal counsel. If you wish Dawson Creek Alliance Church to limit the information collected, or to view your child's information, please contact us.

Child Regestration and Consent Form