GC Youth Laser Tag Night - August 14th, 2026

Date

First Child's Name

Second Child's Name

Third Child's Name

Fourth Child's Name

This address will receive a confirmation email

Phone

Address

First Child's Birthdate

Second Child's Birthdate

Third Child's Birthdate

Fourth Child's Birthdate

First Child's Alberta Health Care #

Second Child's Alberta Health Care #

Third Child's Alberta Health Care #

Fourth Child's Alberta Health Care #

First Child's Gender

Male Female

Second Child's Gender Male Female

Third Child's Gender Male Female

Fourth Child's Gender Male Female

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? (ex: ADHD, autism etc.)

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 this offsite event. 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

Payment

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/Instagram page, we try to post photos that would not be considered objectionable. We will remove any photo immediately upon request.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

GC Youth Laser Tag Night - August 14th, 2026

Description

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