Kids Ministry Registration/Consent 2019-2020


FAMILY INFORMATION:
If both reside at the same address, First name of Parent 1:
Last name of Parent 1:
First name of Parent 2:
Last Name of Parent 2 if not the same as Parent 1:
Address
City
Province
Postal Code
Email 1
Cell Phone 1
Email 2
Cell Phone 2
Home Phone
2ND CONTACT IF PARENTS LIVE SEPARATELY
Parent
Address
Home Phone
Email
Cell Phone
EMAIL PREFERENCE
Which parent(s) should be the contact for Kids Ministry emails?

CHILD'S INFORMATION
First Name
Last Name
Gender
Grade as of Sep 2019
Birth Date (mm/dd/yyyy)
ADDITIONAL INFORMATION
Please provide details regarding any health issues such as food or drug allergies, whether your child wears a "Medical Alert" bracelet, whether your child is on regular medication, and medical conditions:
Is this health issue a "Life Threatening Allergy or Condition"?
Please indicate any social or legal information that will help us care for your child (custody orders, family situations, social behaviours, learning disabilities, etc.)
Emergency Contact Name (We will always attempt to contact parent(s) first and only move to the emergency contact if parent(s) are not reachable)
Emergency Contact Phone
CONSENTS
PICTURE CONSENT: Understanding that WMB does not include the names of minors with their pictures in any promotional material, I consent to the use of pictures/videos taken of my children at activities and events, for website, promotional and reporting purposes.
MEDICAL CONSENT: I consent to let program leaders seek medial attention for my child if I cannot be reached and immediate attention is deemed by the program leaders to be required. It is understood that the leaders will make every effort to continue to contact me in the event of such a medical emergency.
DATA CONSENT: I consent that the information provided through this registration may be added to the WMB church database to be used for church program puposes only, and not to be distributed to any outside party.
RELEASE OF CHILD CONSENT: Children up to grade 3 must be picked up after the service by a parent/guardian. If your child is in grade 4 or grade 5, do you consent to your child being released from the Kids Ministry program and area without a parent/guardian present?
SIGNATURE: In the absence of a paper form to submit, submission of this form implies an electronic submission:


Are Required Fields