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2019-2020 Wellspring Kids’ Registration Form

Nursery to Grade 5

CHILD INFORMATION:
Date of Birth: *
Date of Birth:
Date of Birth:
Date of Birth:
Date of Birth:
Date of Birth:
Date of Birth:
Date of Birth:
FAMILY CONTACT INFORMATION:
Main Home Address: *
Main Home Address:
Phone Number: *
Phone Number:
Contact Person (pick one): *
Emergency Contact (other than parent/guardian): *
Emergency Contact (other than parent/guardian):
Emergency Contact Phone Number: *
Emergency Contact Phone Number:
Please Contact me
PHOTOS/VIDEOS: *
Photos and videos are great ways to remember and promote Children's Ministry Events. Your child(ren) may be included in photos and videos taken at Wellspring Church's Ministry Event.
PERMISSION AND LIABILITY FOR WELLSPRING KIDS' MINISTRY INVOLVEMENT *
I/we, the parents and/or guardians named above, hereby authorize Kaitlyn Radder (Children’s Ministry Director) or one of the Approved Adult Volunteers to use their best judgment in any medical emergency and hereby sign consent for medical treatment and authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above. I/we, the parents and/or guardians named above, undertake and agree to indemnify and hold blameless Wellspring Church, the approved ministry staff/volunteers, its Pastors and Board of Elders from and against any loss, damage, or injury suffered by the participant as a result of being a part of activities representing Wellspring Kids. This consent and authorization is effective only when participating on or traveling to events of `Wellspring Church’. I have read, understood and agree with the above and sign it to cover and give permission for my child(ren) to attend all advertised Wellspring Kids Ministry Events (Excluding overnight events & events outside of Hamilton/Halton Regions for which Additional Permission Forms are required).
Parent/Guardian Name: *
Parent/Guardian Name:
Date of Registration: *
Date of Registration: