Request edit access
2025-2026 Emmanuel Youth Registration and Consent Form
Emmanuel's Youth ministry exists to: To love students where they're at and help them follow Jesus

Information received is confidential and is being gathered for the purposes of serving your teen(s) while in the care of Emmanuel Alliance Church of Ottawa. Any medical information collected here serves to authorize Emmanuel Alliance Church of Ottawa, and its Staff and Volunteers, to obtain medical assistance in emergencies. This form should be completed annually by the Parent / Guardian. 
Sign in to Google to save your progress. Learn more
Email *
First and Last Name of Parent(s) / Guardian *
Mailing Address *
Phone Number of Parent / Guardian *
As parents/guardians, do you attend Emmanel church? If so please tell us which worship service you attend:
First and Last Names of all the Youth in your Family *
Names and Birth Dates of your Youth *
Names of Youth Who Have Been Baptized
Names of Youth / School Name / Grade in September 2025: *
Names of Youth and their Email Address
Names of Youth and Health Card # *
Name and Phone # of Family Doctor (if applicable)
Any Dietary Restrictions or Allergies of Youth? Please provide name of youth and description. 
Does your teen have any physical, emotional, mental, behavioural concerns or limitations that our staff should be aware of? If yes please provide name of youth and explain.
Does your teen require medication to be on hand that our staff should be aware of? If yes please provide name of youth and explain.
Consent Forms
Safety
The safety of your teen is our primary concern. Precautions will be taken for their well-being and protection. I/we, the Parents or Guardians authorize Emmanuel Alliance Church of Ottawa Youth Ministry Staff and Volunteers to sign consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures. I/we, undertake and agree to indemnify and hold harmless Program Personnel, Emmanuel Alliance Church of Ottawa, 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 Emmanuel Alliance Church of Ottawa, as well as of any medical treatment authorized by the supervising individuals representing Emmanuel Alliance Church of Ottawa. This consent and authorization is effective only when participating in or traveling to events sponsored by Emmanuel Alliance Church of Ottawa.
 *
Communication
A policy is in effect that communication is to be used solely for the dissemination of information. Please  indicate to grant permission for Youth Ministry staff and volunteers to communicate with your teen via telephone, email, social media and text.
 *
Photos
Please indicate permission for the reasonable use of pictures containing your teen in any or all of the following ways - Brochures/Promotional material, Church Newsletters, Website, Videotaping
 *
Parents Group Chat
Parents, we have a parent group chat for Jr High and Sr High in English, Cantonese and Mandarin on WeChat and WhatsApp. If you are not already on there and would like to be, please indicate which one you would like to join. 
Clear selection
Purposes and Extent
Emmanuel Alliance Church of Ottawa is collecting and retaining this personal information for the purpose of enrolling your teen in our programs, to assign the teen to the appropriate classes, to develop and nurture ongoing relationships with you and your teen, and to inform you of program updates and upcoming opportunities at Emmanuel Alliance Church of Ottawa.  This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel.  If you wish Emmanuel Alliance Church of Ottawa to limit the information collected, or to view your teen's information, please contact us at office@eaco.ca or 613-820-6774.

Parent / Guardian Consent
I have read, understood and am in agreement with the above. I hereby sign below to cover all Youth Ministry activities for the program year effective as stated below.
Digital Signature
By entering my full name below, I assert that I have reviewed and agree to all the waivers and agreements I selected above.
 *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms