Children’s Ministry Programs

You don’t have to do life alone. Whether you’re brand new or already walking with Jesus — you belong here.

Registration Form for MINISTRY PROGRAMS

Check EACH Program that APPLIES

Child's Name *

Date of Birth *

Street Address *

Town *

Postal Code *

1) Parent's Name

Email Address

Cell

2) Parent's Name

Email Address

Cell

3) Guardian's Name

Email Address

Cell

4) Other individuals who I give permission to pick up my child include:

Email Address

Cell

MEDICAL INFORMATION

EMERGENCY Contact

Cell

is your child on any regular medications that we should be aware of to give optimal care, or do they carry any necessary medications?

Special instructions for caring for your child:

NOTE: Your child/youth must be covered by Ontario Health Insurance or equivalent medical health insurance

Provincial Health Card Number:

Your Physician’s Phone Number:

Name of your Family Physician:

PHOTOGRAPHY

I grant permission to photograph my child for the purpose of posting pictures on the Pioneer Baptist Church website or social media. I grant permission to take picturesYesNo

PIONEER BAPTIST CHURCH EMAILS

I agree to receive occasional emails from Pioneer Baptist Church regarding children’s or family eventsYesNo

DISCLAIMER AND AUTHORIZATION NOTES: PLEASE READ CAREFULLY AND sign below

Precautions are taken for the health and safety of your child, but in the event of accident or sickness, Pioneer Baptist Church, its staff, and volunteers are hereby released from any liability. If your child requires special medication, x-rays, or treatment, every attempt will be made to contact the parents/guardians. Emergency personnel will be called should the situation warrant it.
I authorize administration of any first aid treatment necessary, and in the case of medical emergency, I give my permission to the attending Physician to hospitalize, secure treatment for, and order injection, anaesthesia, or surgery for my child/youth.

I AGREE WITH THE ABOVE DISCLAIMER AND AUTHORIZATION NOTES

Parent/Guardian Signature:

Please Print Name Clearly

Date