2021/2022 Registration *Denotes Required Field * Title Children's Ministries Registration & Consent Form 2021-2022 (Infants through Grade 5) CHILDREN'S MINISTRIES REGISTRATION * Child's Last Name * Child's First Name * Current Grade * Birthday Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 * Age * Gender * Address (incl. unit #) * City * Province * Postal Code * Parent/Guardian 1: Name * Parent/Guardian 1: Primary Phone Number Parent/Guardian 1: Secondary Phone Number Parent/Guardian 2: Name Parent/Guardian 2: Primary Phone Number Parent/Guardian 2: Secondary Phone Number * Household Email Secondary Email Please list any allergies or behavioural concerns that our volunteers should know about. Parent Consent Information collected on this registration form will be used to connect with you and to keep you up-to-date with programs for kids at Bethany Baptist Church. You can unsubscribe from our mailing list at any time. Periodically, we will use pictures and videos of our events on our website. Any photos will be used without names. * I give permission for photos of children's events that may include my child to be used on our church website and in other promotional material. Yes No This consent form gives permission to Bethany Baptist Church to seek whatever medical attention is deemed necessary to treat any injuries or ailments that my child could encounter. I/We the undersigned have legal custody of the student named above, a minor, and have given our consent for him/her to attend events organized by Bethany Baptist Church. I/We understand that there are inherent risks involved in any ministry or athletic event including, but not limited to the following: Sprained or broken limbs, concussion, bruises, and cuts. In the event that my/our child is injured and requires the attention of a doctor, I/we consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a physician and/or hospital personnel designated by Bethany Baptist Church, I/we agree to hold such person free and harmless for any claims, demands, or suits for damages arising from the giving of such consent. I/we also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. Further, I/we affirm that the health insurance information provided above is accurate at this date and will, to the best of my/our knowledge, still be in force for the child named above. I/we also agree to hold harmless and indemnify the releases from any and all liability for any property damage or personal injury to any third party resulting from my child’s participating in the Bethany Baptist Church’s Children's Ministries Program. * Type Name of Child * Parent/Guardian Digital Signature (type name here): * Date Signed: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022