Register Your Child or Youth

Name of Child

Gender

Age (as of September 1)

Grade (as of September 1)

Birth Date (Year / Month / Day)

Contact Phone Number

Contact Email

Address (street, city/town, postal code)

Mother’s Name (or guardian)

Cell Number

Father’s Name (or guardian)

Cell Number

Child lives with

Siblings involved at Argyle Road:

Alternate Emergency Contact Person

Phone Number

Has your child attended Argyle Road Baptist Church programs before?

Yes No

Do you give permission for your child/youth to be photographed or videotaped? (Photos and videos are only used in the church for activities, promo, yearend presentations etc. They are not shared on social media.) (required)

Yes No

Does your child/youth have any behavioral special needs that we should be aware of? (including, but not exclusive to, ASD, ADHD, FAS, anger management, need for one-on-one instruction etc.)

Does your child/youth own a Bible of their own (Grade 1 and up)?

Yes No

If not, would you like us to give them one?

Yes No

I give consent for my child/youth, as named above, to attend Argyle Road Baptist Church children’s/youth programs and any special children’s/youth events that may take place off the church property.

Saskatchewan Health Card Number

Other Health ID (insurance etc.)

Does your child/youth have any medical concerns, allergies or medications we should know about?

I (we), the parent(s) or guardian(s) named above, understand that, in the event medical treatment is required, every effort will be made to contact me. However, if I cannot be reached, I authorize the ministry personnel at Argyle Road Baptist Church to sign consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above.

I (we), named above, undertake and agree to hold blameless the ministry staff, Argyle Road Baptist Church, its Pastors and Board from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Argyle Road Baptist 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 and traveling to and from the events of Argyle Road Baptist Church.

Date Submitted

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