I/we, the parents or guardians maintain that the information contained in this form including emergency contact information, completed for the 2022/2023 school year remains entirely correct for the 2022/2023 school year for student ministries programs and will not hold Kennedy Road Tabernacle responsible for any information that has been withheld or not updated. If I need to change any information on my child's registration form, I will complete a new form entirely.
I/we, the parents or guardians named above, authorize Kennedy Road Tabernacle staff/volunteers 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 Kennedy Road Tabernacle staff/volunteers, its Pastors and Board of Directors from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Kennedy Road Tabernacle, as well as of any medical treatment authorized by the supervising individuals representing the church. This consent and authorization is only for activities at Kennedy Road Tabernacle. You will be notified with a separate Informed Letter of Consent for all events that pose a higher risk, involve transportation or, events that will be held off-site.
In the unlikely event of an emergency requiring a building evacuation, I WILL NOT attempt to retrieve my child from the ministry area, as this will slow down the evacuation process. My child will be evacuated in accordance to the Emergency Response protocols and I will be able to meet my child in the designated safety zone.
I have read, understood and agree with the above and sign it to cover all Student Ministry activities for the program year effective as stated below.
Purposes and Extent
Kennedy Road Tabernacle is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to assign the student to the appropriate classes, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities at our Church. This information will be maintained indefinitely as as it is a requirement of our insurance company and legal counsel. If you wish Kennedy Road Tabernacle to limit the information collected, or to view your child's information, please contact us
Adapted from Plan to Protect® posted with permission 2019