Children & Youth Ministries Registration Form • Maranatha Christian Reformed Church

As part of our Safe Church Policy, we need to collect information regarding your child as well as your permission for enrollment. Any medical information collected here serves to authorize Maranatha CRC, and its Staff and Volunteers, to obtain medical assistance in emergencies. This form should be completed annually by the Parent(s)/Guardian/Care Giver. In the case of custody agreements, please include the proper documentation authorizing Parental contacts.

Please choose below which program (s) your child/youth will be attending: *

Sunday School

Explore (previously Adventure Club)

GEMS

Youth Group

First Name *

Last Name *

Date of Birth: *

Email Address: *

Mailing Address *

Any allergies? *

Yes

If yes, please list:

Emergency Contact Name: *

Phone # *

Parent/Guardian Name and cell number: *

Parent/Guardian Name and cell number:

Special Needs for Your Child:

Does your child have any physical, emotional, mental, behavioural concerns, or limitations that staff should be aware of? *

Yes

If yes, please explain: *

Is your child bringing any medication with him/her? *

Yes

If yes, please list: *

The safety of your child is our primary concern. Precautions will be taken for their well-being and protection.

I/We, the Parents or Guardians named below, authorize Maranatha Christian Reformed Church's Program Personnel 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/We, also agree to indemnify and hold harmless the Program Personnel, Maranatha Christian Reformed Church, and its Leaders from and against any loss, damage, or injury suffered by the participant as a result of being part of the activities of Maranatha Christian Reformed Church, as well as of any medical treatment authorized by the supervising individuals representing Maranatha Christian Reformed Church.

This consent and authorization are effective only when participating in or traveling to events sponsored by Maranatha Christian Reformed Church.

Photos

Please choose below which of the following you will allow your child's photo to be included in: *

Brochures/Promotional Material

Website

Videos

None of the above.

Purposes and Extent

Maranatha Christian Reformed 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 Maranatha Christian Reformed Church. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish Maranatha Christian Reformed Church to limit the information collected, or to view your Childs information, please contact us.

I have read, understood, and agree with the above. *

Yes

Name of Parent/Guardian. *

Date: *

This permission/registration form is in effect from: *

For Parents/Guardians/Care Givers of Youth

A policy is in effect that communication is to be used solely for the dissemination of information. Please sign below to grant permission for Youth Ministry Personnel (staff and volunteers) to communicate with your Child via telephone, email, social media, and text:

Please choose from below: *

Telephone (home/work/cell)

Social Media

None of the above.

I have read, understood, and agree with the above, and my typed name covers all Youth Ministry activities for the program year effective as stated above. A separate Informed Letter of Consent will be sent home for off-site activities and activities of elevated risk.

Name of Parent/Guardian. *