All fields required.

Participant Information

First Name (required)

Last Name (required)

Birthdate (YYYY-MM-DD)

Age

Grade

Gender

Home Address

City

Postal Code

School

Student Cell Phone (if not applicable put NA)

Student Email (if not applicable put NA)

Any allergies, special needs, or behavioural concerns?
NoYes (if yes please explain)

Will medication be brought to along?
NoYes (if yes please ask for a Medication Information Form)

Alberta Health Care #

guardians(s)

Guardian First Name

Guardian Last Name

Relationship

Guardian Cell Phone

Guardian Email

Consent
At youth events, we take pictures to remember events and share the excitement of youth group with others. Unless permission is revoked in writing to the church office, we will assume this is permissible.

If the participant’s phone number(s) and/or email are provided, their leaders may use these to contact them for scheduling and connecting. Other forms of documentable electronic communication may also be used. Unless permission is revoked in writing to the church office, we will assume these are permissible. In the event that another individual attending an event this participant is involved in tests positive for COVID-19, the participant's contact information will be used for contact tracing.

I hereby give permission for my child(ren), , to take part and receive the advantages of Ellerslie Road Baptist Church's youth ministry and to be transported for youth activities by bus, church vehicles, and/or private vehicles. In the event of an emergency and medical treatment is required, I give permission to the staff and/or volunteers to obtain treatment as deemed necessary if I cannot be contacted in a reasonable amount of time. I recognize that there are risks inherent in digital meetings my child may be engaged in with Ellerslie Youth, some of these risks include, but are not limited to: cyberbullying, screen capturing, and zoom hijacking. I recognize that there are risks inherent in in-person activities including the potential spread of the novel coronavirus, COVID-19. I waive, hold harmless, or indemnify Ellerslie Road Baptist Church, it's instructors, paid of volunteer staff, successors, heirs and assignees from any action. I do hereby release, forever discharge and agree to hold harmless, Ellerslie Road Baptist Church and the representatives thereof from any and all liability claims or demands for personal injury, sickness, or death, as well as property damage and expenses of any nature whatsoever which may be incurred by my child in the course of participation in the aforementioned. Furthermore, I agree to assume all responsibility for any of the previously mentioned occurrences.

Guardian's Printed Name
Guardian's Signature