CLCC Grade 4-6 Group Registration Form 2023/24

12731 Old Hope Road, Charlie Lake, BC, V0C 1H0
(250)-785-1723
office@charlielakechurch.com
www.charlielakechurch.com

Family and Parent/Guardian Information:

Parent/Guardian Name #1

Relationship to Child

Phone Number

Mailing Address

Parent/Guardian Name #2

Relationship to Child

Phone Number

Mailing Address

Medical Release:

Precautions are taken for the safety and health of your child, but in the event of accident or sickness, CLCC, its staff, and its volunteers are released from any liability. In the event that a child requires medical attention, parents/guardians will be notified immediately.
In case of emergency, I/we consent to and authorize emergency medical treatment for the Participant in the event of accident, injury, or illness during the programs at CLCC. I/we agree to indemnify and hold blameless the ministry staff, the church, the pastors and the Church board from and against any loss, damage, of injury suffered by the participant(s) as a result of being part of the activities of the church, as well as any medical treatment authorized by the supervising individuals representing the church. This consent is effective when participating in or travelling to events of CLCC.

Parent/Guardian Signature

Date

Media Release:

Your children listed on this form may be videoed/photographed while participating in programs/activities. Any videos/photos taken by Charlie Lake Community Church would only be used to promote our programs/activities. By signing this registration, you are authorizing CLCC to use videos/pictures on the Church website, bulletin boards or other Church social media sites to promote CLCC. We will never reference your child by name or provide specific information on your child. The videos/pictures will only be used by CLCC to show the many ways our children and youth can have fun while participating in our programs/activities. You may withdraw this permission at any time.

Parent/Guardian Signature

Date

Release Permissions:

As part of our Safe Church Policy, only the parent/guardian who signs a child in to a program or activity may sign that child out. However, we understand that occasionally circumstances arise, and you need to have someone else pick up your child. Please list below any individuals over the age of 16 who are authorized to sign your child(ren) out of our programs/activities.

Names:

Children's Information:

Child #1

Name of Child

Gender

Male Female

Date of Birth

Age

Grade (entering in fall)

BC Care Card Number

Does your Child have any food allergies?

Does your child have any severe or life-threatening allergies?

Yes No

If yes, please explain

Is your child bringing any medication with him or her?

Yes No

If yes, please explain

Does your child have any physical, emotional, mental or behavioural concerns or limitations that our staff should be aware of?

Yes No

If yes, please explain

Child #2

Name of Child

Gender Male Female

Date of Birth

Age

Grade (entering in fall)

BC Care Card Number

Does your Child have any food allergies?

Does your child have any severe or life-threatening allergies? Yes No

If yes, please explain

Is your child bringing any medication with him or her? Yes No

If yes, please explain

Does your child have any physical, emotional, mental or behavioural concerns or limitations that our staff should be aware of? Yes No

If yes, please explain

Child #3

Name of Child

Gender Male Female

Date of Birth

Age

Grade (entering in fall)

BC Care Card Number

Does your Child have any food allergies?

Does your child have any severe or life-threatening allergies? Yes No

If yes, please explain

Is your child bringing any medication with him or her? Yes No

If yes, please explain

Does your child have any physical, emotional, mental or behavioural concerns or limitations that our staff should be aware of? Yes No

If yes, please explain

Child #4

Name of Child

Gender Male Female

Date of Birth

Age

Grade (entering in fall)

BC Care Card Number

Does your Child have any food allergies?

Does your child have any severe or life-threatening allergies? Yes No

If yes, please explain

Is your child bringing any medication with him or her? Yes No

If yes, please explain

Does your child have any physical, emotional, mental or behavioural concerns or limitations that our staff should be aware of? Yes No

If yes, please explain

CLCC Grade 4-6 Group Registration Form 2023/24

Description

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