Summer Kids Club • Westside Community Church

Summer Kids Club 0

First Name *

Date of Birth *

Last Name *

Preferred Name

School Grade

Tip: For school year 2025-2026. What grade is the child going into in September.

Gender

Tell us a little bit about your child, interests, likes, dislikes, etc.

Emergency Contact Details

Emergency Contact Name: *

Tip: First and Last Name

Phone Number *

Email Address *

Contact Relationship to Child *

Do you or the child have any church affiliation in Lethbridge? *

Yes

Tip: Do you have a home church that you or the child attends regularly.

How did you find out about the Summer Kids Club? *

If invited by a friend, who?

Tip: We want to make sure that your friend will be in your group!

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 Kids Summber Club care 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.

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 Kids Summer Club 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 Kids Summer Club 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 Kids Summer Club 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

Date & Time

Summer Kids Club 0

Emergency Contact Details

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 Kids Summber Club care group.

Confidential Medical Report

Parental Consent: