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Highlands United Church Children and Youth Program Registration Form 2019/2020
Please complete this form for all children and youth age 0 through grade 12 who may participate in Youth Groups, choirs or Sunday morning programming, including nursery care. Please complete a separate form for each child. You may write 'same' in text boxes that contain duplicate information.
Name of parent(s)/guardians
First Name(s) *
Your answer
Last Name(s) *
Your answer
Contact Information
Address *
Apartment and/or House Number, Street
Your answer
City *
Your answer
Province *
Your answer
Postal Code *
Your answer
Email Address *
Most correspondence with families is done by email so please make sure this is an address you check regularly
Your answer
Home phone number *
Your answer
Alternate Phone number (cell or work)
Your answer
Child's information
Name of Child *
Preferred first name and last name
Your answer
Gender *
Your answer
Birthdate *
dd/mm/yyyy
Your answer
Grade as of September 2019 *
use N for nursery, PS for Preschool or K for Kindergarten
Your answer
School Attending *
Your answer
BC Care Card Number *
Your answer
Allergies, Dietary Restrictions, Special Needs or other comments *
Please provide as many details as possible to help us ensure your child's well being during his/her time at Highlands
Your answer
What groups at Highlands does the child participate in? *
Please check all that apply even if child only attends occasionally.
Required
Permission & Release
Highlands occasionally uses photos of the children and youth in its print and web publications. By clicking 'I agree' below, you give us permission to use your child/ren's photograph in this way. Names of children are not used.

Occasionally during the service, the children may take a short walk with their class to the park or go outside for an activity under the supervision of their teacher(s) By checking 'yes' for the permission question, you give us permission to include your child in these outdoor activities.

If your child is in one of the choirs, you will also be asked to sign a print media recording and publications release form.
Do you agree to allow Highlands to use your child/ren's photograph in print or web publications? *
Do you give permission for your child to participate in supevised outdoor activities or walks during youth group or the Sunday School time? *
Do you have any other comments or questions?
Your answer
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