Westside Nursery Registration Form • Westside Community Church

Westside Nursery (Children Under 3 years old) Program Registration Form

You only need to fill the form out once each school year, we will be taking attendance weekly.

But this will help us to know who would be coming and update contact information.

Thank you.

Personal Contact Details

Family Name *

Date of Birth

Name of Child *

Preferred Name

Phone Number

Email Address *

Tip: Event updates will be communicated mostly through email.

School Grade *

Tip: What grade are you currently attending. If during the summer, what grade will you be going into.

Home Address

Home City

Home Province

Home Postal Code

Emergency Contact Details

Emergency Contact 1

Contact 1 Relationship to child

Contact 1 Phone Number

Tip: Numbers only, no dashes or spaces

Emergency Contact 2

Contact 2 Relationship to child

Contact 2 Phone Number

Tip: Numbers only, no dashes or spaces

Please give details (name and phone number) of other persons who you authorize to collect your child in your absence, while in the care of the above-named group.

Name and Phone Number

Are there any family situations we should be aware of? e.g. custodial issues, other matters (please specify)

Confidential Medical Report

The information below is requested to assist in case of any illness or accident. This information will be held in confidence.

medical consent *

I authorize the leader/s in charge of the above mentioned group where it is impractical to communicate with me, to arrange for my child to receive medical treatment as the leader/s may deem necessary at any time during the activities of Westside Community Church. I appreciate that every care will be taken by the leaders and those connected with that group cannot be held responsible for personal injury, loss or theft of property affecting my child.

Parental Consent

PRIVACY INFORMATION:

All the information recorded on this form is collected and managed in accordance with Westside Community Church's Children's Ministry Policy.

This information has been collected for the primary purpose of Westside Community Church children's ministry and may be used for any activities conducted or promoted by the Westside Community Church.

If you do not want this information to be used for any other purpose other than children's programs, please notify us in writing.

PERMISSION TO PARTICIPATE IN PROGRAM ACTIVITIES AND TO VIEW VIDEO TAPES AND DVDS:

In consideration of the Participant being permitted to engage and take part in Westide Kids Programs being offered, carried on, sanctioned, or sponsored by Westside Community Church of Lethbridge, the undersigned Parent or Guardian of the Participant hereby releases and undertakes and agrees to save harmless and keep indemnified Westside Community Church of Lethbridge, its principals, officers, agents, officials, servants, organizers, and representatives from and against all claims, actions, costs and expenses and demands whatsoever in respect of death, injury, loss or damage to the person or property of the Participant, howsoever caused, regardless of whether same may have been contributed to or occasioned by the negligence of Westside Community Church of Lethbridge, its principals, officers, agents, officials, servants, organizers, and representatives. The Parent/Guardian and the Participant understand and agree that the activities involved in Westside Kids Program may include, but are not limited to active worship, games, Bible teaching, and various activities in the church campus. The Parent/Guardian and the Participant understand and agree that participation in these activities may involve an inherent danger and it is not possible to make these activities completely safe or free from risk. The Parent/Guardian and the Participant willingly accept all the risks and dangers therein. It is hereby acknowledged and agreed that the contents hereof are fully understood by the Participant (and Parent/Guardian) who agree(s) that same shall be binding upon (his/her/their) heirs, successors, executors, administrators and assigns.

PHOTOGRAPHIC PERMISSION:

I hereby grant permission to the leaders and teachers in the Westside Kids Program of Westside Community Church of Lethbridge to photograph and/or video record the named Participant for program and general church use including, but not limited to, videos, photo directories and website galleries/social media.

I have read the Parental Consent and will give my consent. *

Yes