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Welcome to Kennedy Road Kid's ministry!

Information received is confidential and is being gathered for the purposes of serving your child while in the care of Kennedy Road Tabernacle. Any medical information collected here serves to authorize Kennedy Road Tabernacle, and its staff and volunteers to obtain medical assistance in emergencies.

I/we, the parent(s) or guardian(s) maintain that the information contained in this form including emergency contact information, completed for the 2020/21 school year remains entirely correct and unchanged for my child. I hereby give Kennedy Road Tabernacle permission to consider this information entirely correct for the 2020/21 school year for kid's ministry 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 Elders 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 seperate 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.

Acknowledgement of Covid-19 guidelines and responsibilities

I am aware that should my child be exhibiting symptoms of Covid-19, they should not enter the premise. Should my child be ill or exhibiting any symptoms of Covid-19 prior to arrival at church they will be required to stay home and I/we will seek medical attention. If my child(ren) or anyone in the household have travelled outside of Ontario within the last 14 days, they will not be permitted into the program and should be kept home to self-isolate. If my child(ren) present symptoms of Covid-19 while at kid's church, he/she will be safely isolated and I/we will be contacted to pick up the child(ren). I have communicated social distancing expectations to my child(ren) to the best of there age appropriate understanding.

Children in grades 1-5 must arrive at church wearing a mask or face covering, which must cover the nose, mouth and chin, without any gaps. Reasonable exceptions on the requirement to wear masks will apply. (e.g. students with sensory or breathing difficulties) Families should contact the church when registering if they require an exception/accomodation.

I am aware that in order for my child(ren) to attend children's services I must complete the weekly pre-registration at the website kennedyroad.church. I am aware that my child(ren) will be screened prior to entering children's church. Screening and check-in will open 15 minutes prior to service and will close 10 mins after service has began. I will adhere to the social distancing markers at check-in. Due to the enhanced nature of the screening process no one arriving later then 10 minutes after service begins will be admitted regardless of pre-registration.

I have read, understood and agree with the above and sign it to cover all kid's ministry activities for the program year effective as stated below.

First Parents/Guardians Name

First Name*

Last Name*

Phone*
First Parents/Guardians Date of Birth*
I certify that I am 18 years of age or older
First Parents/Guardians Signature*
Second Parents/Guardians Name

First Name*

Last Name*
Second Parents/Guardians Date of Birth*
Third Parents/Guardians Name

First Name*

Last Name*
Third Parents/Guardians Date of Birth*
Fourth Parents/Guardians Name

First Name*

Last Name*
Fourth Parents/Guardians Date of Birth*
Fifth Parents/Guardians Name

First Name*

Last Name*
Fifth Parents/Guardians Date of Birth*
Sixth Parents/Guardians Name

First Name*

Last Name*
Sixth Parents/Guardians Date of Birth*
Seventh Parents/Guardians Name

First Name*

Last Name*
Seventh Parents/Guardians Date of Birth*
Eighth Parents/Guardians Name

First Name*

Last Name*
Eighth Parents/Guardians Date of Birth*
Ninth Parents/Guardians Name

First Name*

Last Name*
Ninth Parents/Guardians Date of Birth*
Tenth Parents/Guardians Name

First Name*

Last Name*
Tenth Parents/Guardians Date of Birth*
Parents/Guardians 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*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
Emergency Information
My child(ren) registered were born between January 1, 2010 and December 31, 2014.*
No
Yes

Health Card Number *

Family Doctor *

Doctor's Phone Number *
Does your child have any allergies?*
No
Yes

If yes, please list:
Will your child be bringing an Emergency Medication with them? (If yes please expect an Emergency Medication Form in your email.)*
No
Yes
Does your child have any custody alert instructions? In case of custody agreements, please provide documentation.*
No
Yes

Does your child have any physical, emotional, mental, behaviour concerns, or limitations that we should be aware of? If yes, please explain. *
Kennedy Road Tabernacle Photo consent:*
I authorize the use of my child's photo in online or print format for Internal Promotional Purposes.
I authorize the use of my child's photo in online or print format for External Promotional Purposes.
I authorize the use of my child's photo in online or print format for Internal and External Promotional Purposes.
I DO NOT authorize the use of my child's photo.
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*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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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