2025-2026 Youth Registration

Basic Information

Parent/Guardian Name

This address will receive a confirmation email

Cell Phone

Home Phone

Address

Student's Full Name

Student's Contact Information

Student's Birthdate

Grade

School

2nd Student's Name

Contact Information

Grade

School

Birthdate

3rd Student's Name

Contact Information

Grade

School

Birthdate

Health Information

This medical information serves to authorize Oak Park Church of Christ, and its Staff and Volunteers, to obtain medical assistance in emergencies.

Alberta Health Card Number

Family Doctor

Allergies (If no, please put N/A)

Epi-Pen

Emergency Contact (Not Parent/Guardian)

Does your student have any physical, emotional, mental, or behavioural concerns or limitations that staff and volunteers should be aware of?

Select One

Yes No

If yes, please explain:

Is your student bringing any medication, including inhalers, to Youth Group?

Select One

Yes No

If yes, please list with instructions for use.

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

I understand that all reasonable safety precautions will be taken by the leaders and volunteers during the events and activities.

In the event of an emergency, I authorize the leaders or volunteers to seek medical treatment for my child as deemed necessary. I agree to hold harmless and indemnify Oak Park Church of Christ, its leaders, employees, volunteers, and agents from any liability, claims, demands, and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by my child while participating in youth ministry activities.

By writing your name below you agree to the above statements.

Parent/Guardian Name (First and Last)

Media Release

Please select one of the following

Communication

A policy is in effect that communication is to be used solely for the dissemination of information. Please check the boxes below to grant permission for Youth Ministry Personnel (staff and volunteers) to communicate program details with your child via telephone, email, social media, and/or text.

You May Select Multiple Options:

Telephone Email Social Media Text Messages None

Select One

Yes No

Checking Out

By selecting "yes" below, I, the above-named parent/guardian, hereby give my child, the above-named student, permission to check his/herself out at the end of the Youth Group Program at Oak Park Church of Christ. I understand that Oak Park Church of Christ will not be liable for anything that happens to my child once he/she leaves the Youth Group Program.

Select One

Yes No

Extra-Curricular Activities

Oak Park youth staff and volunteers would love to support youth in their activities outside of school. With permission, can Oak Park staff and volunteers attend extra-curricular events to support youth? If so, please indicate which activities they are a part of.

List activities

Parent/Guardian Options:

Oak Park Church of Christ is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities at Oak Park Church of Christ. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish Oak Park Church of Christ to limit the information collected, or to view your child's information, please contact us. I have read and understood and agree with the above and by clicking submit I agree to cover all Youth Ministry activities for the program year effective September 1, 2025, to August 31, 2026. A separate Informed Letter of Consent will be sent home for off-site activities and activities of elevated risk.

Date of Submission:

2025-2026 Youth Registration

Description

Please Fix the Following