Name (Required)

Email Address (Required)

Parent / Guardians Names (Required)

Your Phone Number (Required)

Emergency Contact (Required)

Birthday (Required)

Your Address (Required)

Grade (Required)

Gender of Youth (Required)

Age (Required)

Does your child have any physical, emotional, mental, behavioral concerns or limitations that our staff should be aware of? If yes, please explain. (Required)

Is your child bringing any medication with him/her? If yes, please list. (Required)

I give permission for my child to participate in offsite and onsite events sponsored by Delburne Gospel Church (DGC). (Required)

I understand that any events requiring transportation outside of our normal ministry radius (>50km), overnight events, and/or mission trips will require a separate, special consent form to be completed. (Required)

In the event of medical emergency, I give permission for my child to receive First Aid/medical treatment as determined by Staff or Volunteers, and/or to be transported to the nearest medical facility by Staff or Volunteers or Emergency Services. (Required)

I recognize that there are risks inherent in activities/transportation that my child may be engaged in, and I will not hold DGC Staff or Volunteers responsible for any personal injury that might occur to my child while participating. If my child commences (Required)

I understand that photographs or video may be taken of my child during DGC events, and I give permission to use any of these photos/videos for any and all DGC ministry purposes. I release and discharge the photographer/videographer and DGC Staff or Volunte (Required)

I have read, understood and agree with the above and for it to cover all Youth Ministry activities for the program year effective as stated above. (Required)