Gospel Centre Student Registration Form 2023-2024

Student's Information

Name

Phone

Address

Birthdate

Alberta Health Care #

School

Grade

Gender

Female Male

Allergies - Does this student have any allergies that we should be aware of? Please list them below:

Do you have any special instructions or physical, emotional, mental, or behavioral concerns/limitations for this student that we should be aware of?

How did you hear about GC Youth?

Parent/Guardian's Information

First Parent/Guardian's Full Name

First Parent/Guardian's Cell Phone

First Parent/Guardian's Email

This address will receive a confirmation email

Address (if different than above)

Second Parent/Guardian's Full Name

Second Parent/Guardian's Cell Phone

Second Parent/Guardian's Email

General Info, Permissions & Legal Consent

What church do you attend? If you don't attend church, enter "none."

Would your child/student like to be involved with GC Youth in any of the following areas? Check all that you are interested in.

Music Prayer Leadership Tech Team Serving Drama None of the Above

Would you like to receive weekly emails with the current week's GC Youth event information?

Yes No

PERMISSION: Do we have your permission to follow up with your student via text?

Yes No

INFORMED CONSENT: In the event of an emergency I grant permission for my child to be examined by a physician or nurse in case of accident or illness if taken to an emergency room. I understand I will be contacted immediately. Further, I will hold harmless or indemnify Gospel Centre Pentecostal Church for any loss or injury that may be sustained. I recognize that there are risks inherent in activities my child may be engaged in and, again, I waive, hold harmless, or indemnify Gospel Centre Pentecostal Church, its instructors, paid or volunteer staff, successors, heirs, and assigns from any action.

Informed Consent

Yes No

Parent/Guardian Signature

Date Signed

WAIVER: I hereby give permission for my child to be photographed and/or filmed without any reimbursement of any kind due to me or the need to pay any fee. Gospel Centre Pentecostal Church considers all information personal and confidential and will only use it within the church for ministry or other church related activities and will not release it to outside parties or organizations.

Yes No

Parent/Guardian Signature

Date Signed

OFF-SITE PERMISSION: I/We, the undersigned parent(s) or legal guardian(s) for the named child above, give our permission for our child to participate in onsite or offsite events between September 2023 and August 31, 2024. We also give permission for any representative of Gospel Centre Pentecostal Church to obtain any necessary medical treatment as needed while offsite. We assume responsibility for any medical bills incurred and should our child have to return home before the group for medical or disciplinary reason, we also hereby assume any cost incurred. We give authorization for the previously mentioned to provide all necessary food, transportation, and lodging as applicable. We do hereby release, forever discharge and agree to hold harmless, Gospel Centre Pentecostal Church, its pastors, staff, and representatives thereof from any and all liability claims, or demands for personal injury, sickness, or death, as well as property damage and expenses of any nature whatsoever which may be incurred by my child in the course of participation in the aforementioned. Furthermore, we agree to assume all responsibility for any of the previously mentioned occurrences.

Yes

Parent/Guardian Signature

Date Signed

Emergency Contact Name

Emergency Contact Phone Number

Doctor's Name

Doctor's Phone Number

Gospel Centre Pentecostal Church considers all personal information as confidential and will not release it to outside parties or organizations. However, by completing this form, you are providing consent for this information to be used within the church for ministry and other church related activities. when using photos of Gospel Centre events, either on our website or on Gospel Centre's Facebook page, we try to post photos that would not be considered objectionable. We will remove any photo immediately upon request.

Gospel Centre Student Registration Form 2023-2024

Description

Please Fix the Following