Cheltenham Baptist Church Youth/Child Registration Form
I hereby give permission for my child to attend the following at Cheltenham Baptist Church: *
Email address *
Ministry *
Parent or Guardian Name *
Your answer
Parent Phone Number *
905-XXX-XXXX
Your answer
Alternate Phone Number *
905-XXX-XXXX
Your answer
Street Address *
Your answer
City *
Your answer
Province *
Your answer
Postal Code *
Your answer
Youth Name *
Your answer
Youth Date of Birth *
MM
/
DD
/
YYYY
Youth Gender *
Youth Allergies/Medical Conditions
Your answer
Dietary restrictions *
Family Doctor *
Your answer
Family Doctor Phone Number
905-XXX-XXXX
Your answer
Youth Health Card Number *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Number *
905-XXX-XXXX
Your answer
Will be Brought By
Your answer
Will be Picked Up By
Your answer
I Would Like to Help With (if any)
I Can Help on These Days
I understand that the programs involve the children participating in sports, crafts and games. These sports, crafts and games may be played indoors or outdoors. I understand that the children will be under the direction and supervision of one or more adult leaders, approved of by Cheltenham Baptist Church. I hereby waive any claim against Cheltenham Baptist Church, and its approved leaders for any accident, injury or illness that may occur while my child is participating in the Sunday School/ Dragonflies/ Fireflies programs of Cheltenham Baptist Church. In the event of an Emergency, I understand every effort will be made to contact me. In the event that I cannot be reached, I hereby give my permission to the physician selected by the adult leader in charge to secure treatment for my child that is deemed necessary by the attending physician. I have noted my child?s relevant medical condition (s) and allergies, if any. *I have read and accept the above terms: *
Upon submission you will be sent a link for payment through our givings page or I understand that I will have to pay $$ upon arrival *
On-line payments for Vacation Bible Camp or any of the youth programs can be made by clicking the DONATE NOW link and selecting Vacation Bible Camp or Youth and Children's Programs in the Your Donation Will Support menu
Required
A copy of your responses will be emailed to the address you provided.
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