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HOPE YOUTH

Registration and Consent Form

2020/2021

Information received is confidential and is being gathered for the purposes of serving your Child while in the care of Hope Church Toronto West. Any medical information collected here serves to authorize Hope Church Toronto West, and its Staff and Volunteers, to obtain medical assistance in emergencies. This form should be completed annually by the Parent / Care Giver.

The safety of your Child is our primary concern. Precautions will be taken for their well-being and protection.

I/we, the Parents or guardians named below, authorize the Youth Director or one of Hope Church Toronto West Youth Ministry Workers 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 below, undertake and agree to indemnify and hold harmless Hope Church Toronto West, its Ministry Workers, and its Leaders from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Hope Church Toronto West, as well as of any medical treatment authorized by the supervising individuals representing Hope Church Toronto West. This consent and authorization is effective only when participating in or traveling to events sponsored by Hope Church Toronto West.

PHOTOS: By signing this consent form you are granting permission for the reasonable use of pictures containing your Child in any or all of the following ways: Promotional material, Church Social Media and Website, Newsletters and Videotaping.

PURPOSES AND EXTENT: Hope Church Toronto West is collecting and retaining the following 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 organization. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish Hope Church Toronto West to limit the information collected, or to view your child’s information, please contact us.

PARENTING/GAURDIAN OPTIONS: By signing this consent form you are confiming that you have read, understood and agree with the above, and sign it to cover all Youth Ministry activities for the program year. A separate Informed Letter of Consent will be sent home for offsite activities and activities of elevated risk, inlcuding online video engagement through zoom. 

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Email *

Health Card Number

Name & Number of Family Doctor

Allergies *
Does your Child have any physical, emotional, mental, behavioural concerns or limitations that staff should be aware of?*
No
Yes

If yes, please explain.
Is your Child bringing any medication with him/her?*
No
Yes

If yes, please list.
COMMUNICATION: A policy is in effect that communication is to be used solely for the dissemination of information. Please sign below to grant permission for Youth Ministry Workers(staff and volunteers) to communicate with your Child via telephone, email, social media and text:
Telephone
Text Message
Email
Social Media
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Email *

Health Card Number

Name & Number of Family Doctor

Allergies *
Does your Child have any physical, emotional, mental, behavioural concerns or limitations that staff should be aware of?*
No
Yes

If yes, please explain.
Is your Child bringing any medication with him/her?*
No
Yes

If yes, please list.
COMMUNICATION: A policy is in effect that communication is to be used solely for the dissemination of information. Please sign below to grant permission for Youth Ministry Workers(staff and volunteers) to communicate with your Child via telephone, email, social media and text:
Telephone
Text Message
Email
Social Media
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Email *

Health Card Number

Name & Number of Family Doctor

Allergies *
Does your Child have any physical, emotional, mental, behavioural concerns or limitations that staff should be aware of?*
No
Yes

If yes, please explain.
Is your Child bringing any medication with him/her?*
No
Yes

If yes, please list.
COMMUNICATION: A policy is in effect that communication is to be used solely for the dissemination of information. Please sign below to grant permission for Youth Ministry Workers(staff and volunteers) to communicate with your Child via telephone, email, social media and text:
Telephone
Text Message
Email
Social Media
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Email *

Health Card Number

Name & Number of Family Doctor

Allergies *
Does your Child have any physical, emotional, mental, behavioural concerns or limitations that staff should be aware of?*
No
Yes

If yes, please explain.
Is your Child bringing any medication with him/her?*
No
Yes

If yes, please list.
COMMUNICATION: A policy is in effect that communication is to be used solely for the dissemination of information. Please sign below to grant permission for Youth Ministry Workers(staff and volunteers) to communicate with your Child via telephone, email, social media and text:
Telephone
Text Message
Email
Social Media
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Email *

Health Card Number

Name & Number of Family Doctor

Allergies *
Does your Child have any physical, emotional, mental, behavioural concerns or limitations that staff should be aware of?*
No
Yes

If yes, please explain.
Is your Child bringing any medication with him/her?*
No
Yes

If yes, please list.
COMMUNICATION: A policy is in effect that communication is to be used solely for the dissemination of information. Please sign below to grant permission for Youth Ministry Workers(staff and volunteers) to communicate with your Child via telephone, email, social media and text:
Telephone
Text Message
Email
Social Media
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Email *

Health Card Number

Name & Number of Family Doctor

Allergies *
Does your Child have any physical, emotional, mental, behavioural concerns or limitations that staff should be aware of?*
No
Yes

If yes, please explain.
Is your Child bringing any medication with him/her?*
No
Yes

If yes, please list.
COMMUNICATION: A policy is in effect that communication is to be used solely for the dissemination of information. Please sign below to grant permission for Youth Ministry Workers(staff and volunteers) to communicate with your Child via telephone, email, social media and text:
Telephone
Text Message
Email
Social Media
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Email *

Health Card Number

Name & Number of Family Doctor

Allergies *
Does your Child have any physical, emotional, mental, behavioural concerns or limitations that staff should be aware of?*
No
Yes

If yes, please explain.
Is your Child bringing any medication with him/her?*
No
Yes

If yes, please list.
COMMUNICATION: A policy is in effect that communication is to be used solely for the dissemination of information. Please sign below to grant permission for Youth Ministry Workers(staff and volunteers) to communicate with your Child via telephone, email, social media and text:
Telephone
Text Message
Email
Social Media
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Email *

Health Card Number

Name & Number of Family Doctor

Allergies *
Does your Child have any physical, emotional, mental, behavioural concerns or limitations that staff should be aware of?*
No
Yes

If yes, please explain.
Is your Child bringing any medication with him/her?*
No
Yes

If yes, please list.
COMMUNICATION: A policy is in effect that communication is to be used solely for the dissemination of information. Please sign below to grant permission for Youth Ministry Workers(staff and volunteers) to communicate with your Child via telephone, email, social media and text:
Telephone
Text Message
Email
Social Media
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Email *

Health Card Number

Name & Number of Family Doctor

Allergies *
Does your Child have any physical, emotional, mental, behavioural concerns or limitations that staff should be aware of?*
No
Yes

If yes, please explain.
Is your Child bringing any medication with him/her?*
No
Yes

If yes, please list.
COMMUNICATION: A policy is in effect that communication is to be used solely for the dissemination of information. Please sign below to grant permission for Youth Ministry Workers(staff and volunteers) to communicate with your Child via telephone, email, social media and text:
Telephone
Text Message
Email
Social Media
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Email *

Health Card Number

Name & Number of Family Doctor

Allergies *
Does your Child have any physical, emotional, mental, behavioural concerns or limitations that staff should be aware of?*
No
Yes

If yes, please explain.
Is your Child bringing any medication with him/her?*
No
Yes

If yes, please list.
COMMUNICATION: A policy is in effect that communication is to be used solely for the dissemination of information. Please sign below to grant permission for Youth Ministry Workers(staff and volunteers) to communicate with your Child via telephone, email, social media and text:
Telephone
Text Message
Email
Social Media
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive the Hope Youth weekly newsletter
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Email *

Health Card Number

Name & Number of Family Doctor

Allergies *
Does your Child have any physical, emotional, mental, behavioural concerns or limitations that staff should be aware of?*
No
Yes

If yes, please explain.
Is your Child bringing any medication with him/her?*
No
Yes

If yes, please list.
COMMUNICATION: A policy is in effect that communication is to be used solely for the dissemination of information. Please sign below to grant permission for Youth Ministry Workers(staff and volunteers) to communicate with your Child via telephone, email, social media and text:
Telephone
Text Message
Email
Social Media
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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