Grade 5&6 Registration Form

Grade 5&6 Registration Form 2020
STUDENT INFORMATION

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Gender*

Campus

Custody Concerns

HOUSEHOLD INFORMATION

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PARENT/GUARDIAN INFORMATION
PARENT 1
Relationship to student: (please select)

( )   -

( )   -

Custody (Please select)

PARENT 2
Relationship to student: (Please select)

( )   -

( )   -

Custody (Please select)

INFORMED CONSENT AGREEMENT:
I, the parent or legal guardian names on this registration, give permission for:
(a) The student named on this form to participate in the Centre Street Church Grade 5&6 Ministry Program, and
(b) Staff members of Centre Street Church to authorize any physician to hospital to provide medical assessment, treatment, or procedures for the student if necessary while the student is participating in the Centre Street Church Youth Ministry Program.
 
I understand that the personal information in this form is being collected for the purpose of enrolling my Student in the Centre Street Church Grade 5&6 Program, to assign the Student to the appropriate groups, to develop and nurture ongoing relationships, and to inform me of program updates and upcoming opportunities in Grade 5&6 Ministries and Centre Street Church via digital and online media. Attendance for students involved will be collected and stored for all  groups, events, retreats and other Grade 5&6 Ministry gatherings.
I understand that my personal information is protected under the Personal Information Protection Act.
I have read and agree to the Informed Consent Agreement*

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