Temple Baptist Church
913 1st Street S
Contact us at (204) 734-4200 or

*One form must be filled out per child
We will follow Manitoba Health guidelines for safety purposes, which will include hand washing, as much physical distancing as possible, as well as single serve snacks, if served. Parents are asked to self-screen their child and remain home if they exhibit any of the following symptoms: fever, cough, difficulty breathing, unusual aches and pains. *These guidelines will be updated as per Manitoba Health as they change.*
Name of Child *
Parent/Guardian Name(s) *
Email *
Phone Number *
Gender *
Date of Birth *
Age *
Child is/or is entering... *
Allergies/Health Information we should be aware of *
Due to COVID-19 guidelines and protocol, I understand that I am responsible to pick up my child from his/her Discovery Room classroom, as soon as possible following the service, and that he/she WILL NOT be released on their own. *
I understand I will need to self-screen my child at home prior to attending, and will remain home if my child has any symptoms as per Manitoba Health requirements. *
Protecting Your Personal Information
Your child's health information is collected in case of a health emergency and to ensure the safety and well-being of each person involved in our program. This information will only be seen by our staff and will be kept in a secure place.
Medical and Photography Authorization
I hereby authorize the staff and volunteers of Discovery Zone at Temple Baptist Church to make any and all decisions regarding the emergency treatment of my child. In the event that my son/daughter requires special medical treatment during his/her participation in such activities, including transportation to and from the activity, I the parent/guardian will be notified immediately. I/We, the parents or guardians named above, authorize the ministry staff of Temple Baptist Church 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, named above, undertake and agree to indemnify and hold blameless the ministry staff, Temple Baptist Church, its pastors and Church Board from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of the Temple Baptist Church, as well as of any medical treatment authorized y the supervising individuals representing the Church. This consent and authorization is effective only when participating in or traveling to events of the Temple Baptist Church.

I also understand they retain the right to use for publicity and advertising purposes, photographs of children taken at church. Children's names will not be used with photos.
Purposes and Extent
Temple Baptist 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 permanently as it is a requirement of our insurance company and legal counsel. If you wish Temple Baptist Church to limit the information collected, or to view your child's information, please contact us.
I, _____________________________ parent/guardian have read, understand, and agree with the above and hereby release and discharge all parties associated with this Discovery Zone program at Temple Baptist Church from any and all claims, demands, actions, and cause of action that I/my child incurs. *
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