Kids Program Registration

PURPOSE AND EXTENT: Home Church is collecting and retaining this personal information for the purpose of create a child profile to be used in the event of an emergency involving first responders, to assign your child to the appropriate classes, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities at our church. This information will be kept confidential and maintained indefinitely, as it is a requirement of our insurance company and our abuse prevention policy.

In the case of custody agreements, please submit the proper form authorizing parental contacts.

If you wish Home Church to limit the information collected, or to view your child's information, please contact us.

HOUSEHOLD INFORMATION

Primary Address

Secondary Address

Primary Contact First and Last Name

Relationship to the Child

Father Mother Legal Guardian Other

Phone Number

Spouse / Alternate Contact First and Last Name

Relationship to the Child Father Mother Legal Guardian Other

Phone Number

CHILD'S INFORMATION

If you have more than 3 children, please complete an additional form.

Name of Child #1

Preferred name (if different)

Date of Birth

Grade in September 2025

Name of Child #2

Preferred name (if different)

Date of Birth

Grade in September 2025

Name of Child #3

Preferred name (if different)

Date of Birth

Grade in September 2025

HEALTH INFORMATION

Information received is confidential and is being gathered for the purposes of serving your child while in the care of Home Church. Any medical information collected here serves to authorize Home Church, and its staff and volunteers, to obtain medical assistance in emergencies.

Allergies / Medical Conditions (Please include the name of the child if there is more than one child on this registration form)

If your child is bringing any medication with him/her, please list the medication

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

NEWSLETTER SUBSCRIPTION

Subscribe to receive our monthly next gen newsletter.

Would you like to receive our monthly next gen newsletter?

Yes No

Would you like newsletter to be sent to...

Primary email only Primary and spouse/alternate emails None

LEGAL ACKNOWLEDGEMENT

MEDICAL

I, named below, acknowledge that it is my responsibility to advise the church of any medical or other conditions that may affect my child’s participation in the event. This includes any prescribed or over-the-counter medication that my child will be carry

MEDICAL TREATMENT

In the event that my child requires medical attention, I, named below, consent to my child being transported to the nearest emergency centre, including by ambulance if necessary, and accept that I am responsible for any costs of such ambulance service.

PHOTO & VIDEO RELEASE

I, named below, authorize Home Church to use any photographs or video taken of my child while participating at Home Church. I understand that they may be used for social media highlights, internal documents, or other marketing initiatives to promote the c

PHOTO & VIDEO RELEASE #2

I, named below, understand that photos of my children may still be used as long as they are facially unrecognizable (i.e. photos taken from behind or group photos where the faces are blurred or too small to be recognizable).

LIABILITY RELEASE: I, named below, undertake and agree to indemnify and hold blameless the Ministry Staff and Volunteers of Home Church, its' Pastors and Board of Elders from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Home Church, as well as of any medical treatment authorized by the supervising individuals representing the church. This consent and authorization is effective only when participating in events of Home Church.

I understand and acknowledge that when my child participates in the next gen programs at Home Church, they are under supervision when they are checked in to the programs they registered to. Parents will resume responsibilities when your child is checked out. I HAVE READ, UNDERSTOOD AND AGREE WITH ALL THE ABOVE AND SIGN IT TO COVER ALL HOME CHURCH NEXT GEN MINISTRY ACTIVITIES FOR THE CURRENT PROGRAM YEAR (September - August).

Your Signed Name

Kids Program Registration

Description

Please Fix the Following