Static Junior Youth Group Registration

We're looking forward to seeing your grades 6-8 child in our Static Junior Youth program! Please take a moment to fill in this important information, so we can register your child.

Parent/Guardian #1:

First Name *

Last Name *

Relationship to child: *

Email Address *

Mobile Number *

Parent/Guardian #2:

First Name (Parent/Guardian #2)

Last Name (Parent/Guardian #2)

Relationship to child (Parent/Guardian #2)

Email Address (Parent/Guardian #2)

Mobile Number (Parent/Guardian #2)

Family Contact Information:

Home Address *

Home City *

Home Province *

Home Postal Code *

Preferred Email *

Child #1 Information:

Full Name (Child #1) *

Gender (Child #1) *

Birthdate (Child #1) *

School Grade (Child #1) *

Medical Information (Child #1)

Tip: any allergies, health concerns, etc.

Registering another child?

Are you registering a 2nd child? *

yes

no I am finished

Child #2 Information:

Full Name (Child #2)

Gender (Child #2)

Birthdate (Child #2)

School Grade (Child #2)

Medical Information (Child #2)

Tip: any allergies, health concerns, etc.

Consent to Participate:

The first time your child attends Static Junior Youth, you will be asked to indicate your agreement by signature to the following:

As parent/guardian of the above named child(ren), I give consent for the above named child(ren) to participate in regular Static Junior Youth programming, run by Common Ground Church. I/We, the parents or guardians named above, authorize the ministry staff/volunteers of Common Ground Church to sign a 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 indemnify and hold blameless the ministry staff/volunteers, Common Ground Church, its pastors and board from and against any loss, damage or injury suffered by the participant resulting from participating in the activities of Common Ground 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 the Static Junior Youth program of Common Ground Church.

Media & Information Disclaimer:

The first time your child attends Static Junior Youth, you will be asked to indicate your agreement by signature to the following optional statement. If you do not agree, then your child's image will not be published in any promotional material.

As part of our ministry at Common Ground Church, we regularly take photos and videos during our events. This media is used for promotional purposes with our church, community and on the internet. Our commitment is to do everything in our power to preserve the security of all children who participate in our programs and events. Therefore, we will not give away or sell this media or any other information that we receive [i.e. the information on this form]. Children's names will never be posted online.

I, this child’s/children’s parent/guardian, consent to this media and information to be stored by Common Ground Church for use within the organization, and for their image to be used in future promotional material via photo, video or otherwise.