EmailMe Form - Youth Permission/Registration Form

Parent/Guardian Information
Parent/Guardian Name *
First Last
Parent/Guardian Phone *
### - ### - ####
Email for Updates *
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Second Parent/Guardian Name (optional)
First Last
Second Parent/Guardian Phone (optional)
### - ### - ####
Student Information
Student *
First Last
Age *
Grade *
Birth Date *
Allergies or Health Concerns *
Anything Else You'd Like Us to Know About Your Student
Emergency Contact
Emergency Contact Phone *
### - ### - ####
Name *
First Last
Relationship to Student *
Participation Waiver
I, the above named parent/guardian, give my voluntary consent for the above named student to participate in activities in association with Fort Saskatchewan Alliance Church.
I release Fort Saskatchewan Alliance Church, it's Elders Board, staff, volunteers and agents from any loss, personal injury, accident misfortune or damage to the above named student or his/her property, with the understanding that reasonable precautions shall be taken to ensure the health and safety of the above named. I understand that Fort Saskatchewan Alliance Church, its staff, volunteers or agents reserve the right to dismiss a participant who is in their opinion a hazard to the safety and wellbeing of others, who appears to have rejected the reasonable guidelines of the activity.
If you accept and agree with the terms and conditions stated above please click "I AGREE."
*
I AGREE
Medical Waiver
Furthermore, I authorize Fort Saskatchewan Alliance Church staff or volunteers to approve and obtain any and all medical attention if deemed necessary; with the understanding that all reasonable attempts have been made to consult with myself beforehand except in the case of minor illness and/or first aid where deemed appropriate. Furthermore, I release Fort Saskatchewan Alliance Church, it's Elders Board, staff, volunteers and agents from any loss, personal injury, accident misfortune or damage to the above named student or his/her property, with the understanding that reasonable precautions shall be taken to ensure the health and safety of the above named. I understand that Fort Saskatchewan Alliance Church, its staff, volunteers or agents reserve the right to dismiss a participant who is in their opinion a hazard to the safety and wellbeing of others, who appears to have rejected the reasonable guidelines of the activity.
If you accept and agree with the terms and conditions stated above please click "I AGREE."
I AGREE
Alberta Health Care Card #
Photography Release
I, the above named parent/guardian, give permission for the above named student to have his/her photograph taken or to be video recorded and understand that it may be used in the following ways: motion picture video, slide shows or still images shown at Fort Saskatchewan Alliance Church during public services or community events, posted to the church website, public church or Youth specific Facebook or Instagram page, or printed for bulletins, posters, invitations or other promotional material.
I understand that by clicking "I AGREE" that I am consenting to my child's photograph or video recording being used in the above stated ways and the risks associated with that. I hereby release Fort Saskatchewan Alliance, its Elders Board, staff, volunteers and agents from any consequences that may occur from the above stated activity.
I AGREE
Transportation Release
I, the above named parent/guardian, give my voluntary consent for the above named student to be transported by staff, ministry leaders or volunteers associated with Fort Saskatchewan Alliance Church. I understand that the mode of transportation may include but is not limited to personal vehicles of Fort Saskatchewan Alliance Church staff, volunteers or agents, rented vehicles and/or commercial vehicles driven by Fort Saskatchewan Alliance Church staff, volunteers or agents. Transportation may include but is not limited to transportation for weekly youth events, off-site events, conferences and other travel associated with Fort Saskatchewan Alliance Church Youth. Furthermore, I will assume all liability for injury that may result during the transport to, from, during the event or at the destination. I release Fort Saskatchewan Alliance Church, it's Elders Board, staff, volunteers and agents from any loss, personal injury, accident and misfortune or damage to the above named student or his/her property, with the understanding that the reasonable precautions shall be taken to ensure the health and safety of the above named.
By clicking "I AGREE", I agree to the above stated terms and conditions, accept full responsibility and grant permission for the above named student to participate in the above named activities.
I AGREE
Signature *
Clear
Youth Survey (opitonal)
1- Would you like to join in the Youth Worship?
Yes
No
I can't sing or play any instrument
2- Are you interested in drama: Theatre & Musicals?
Yes
No
I can't stop laughing on stage
3- Are you good at photography? Do you like to take loads of photos?
Yes
No
Not sure. I like to use filters and stuff
4- Are you tech-savvy? Do you like being backstage managing computers, pro-presenter and operating the sound system?
Yes
No
Not good at it

Parent/Guardian Information

Student Information

Emergency Contact

Participation Waiver

Medical Waiver

Photography Release

Transportation Release

Youth Survey (opitonal)