Millarville Community Church Youth Registration Bundle

This registration bundle includes: Forms 3, 4 and the Youth Questionnaire from the MCC Plan to Protect as well as travel within 100kms of the church for the current year.

Youth Registration

This Portion to be completed by parent or guardian:

Youth's Cell Phone Number (if applicable)

Youth's Date of Birth

While your child is in our care it would be helpful for us to know whether he or she suffers from any allergies or phobias, has any medical conditions or disabilities:

Does your teen have allergies?

Yes

Details of allergies:

Details of any Medication (please ensure an adequate supply is brought to events, if it could be needed and given to one of the organizers)

Details of any dietary requirements:

Parent/Guardian (1) First and Last Name

Parent/Guardian (1) Contact Phone Number

Parent/Guardian (2) First and Last Name

Parent/Guardian (2) Contact Phone Number

Doctor's Address and Phone Number

Any other information you think the organizers should know:

Does your child have any physical, emotional or mental behavioral concerns or limitations that our staff should be aware of?

Teen's Alberta Health Care Number

I give consent to my teen joining and participating in the Millarville Community Church (MCC) Youth Group. I also give consent to my teen taking part in group social events. This does not include high risk events, nights away or trips over 100 kms from MCC. For these events a seperate parent consent form will be required.

I agree to photographs and short videos of activities including my child to be taken for use within the church community and for possible publication including newspaper or internet.

I agree to any emergency treatment to be give as considered necessary and authorize Millarville Community Church staff to sign consent for medial treatment or procedures for the participant named above. I/we, named below agree to indemnify and hold blameless Millarville Community Church, its staff and representatives from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of the Millarville Community Church, as well as any medical treatment authorized by the supervising individuals, representing the church. This consent and authorization is effective only when participating in or traveling to and from events of the Millarville Community Church. In the case of custody agreements, please include the proper form authorizing parental contacts. Information received is confidential unless required by first responders and/or medical professionals.

NB The medical profession takes the view that a parent's consent to medical treatment can not be delegated. Medical consent forms have no legal status and a doctor has the right to insist parental concent before treating a child. We have found however, that medical staff find this type of general consent helpful.

We recognize that circumstances/information changes and if it does it is my responsibility as parent/guardian to make the organizers aware in writing so that changes can be made to the existing form or a new form can be completed.

I agree to the terms & conditions above

Youth Questionnaire - for Youth Board and Fall Planning

This Section to be completed by the Youth:

Favorite Food/Snacks:

Favorite Bible Verse

What do you want to be when you grow up?

Hobbies/Current Interests/Skills you would like to learn:

What would you like members of the church to know about you?

Would. you like to be connected with a mentor in the church? (Someone to pray for you and chat with?)

Other Areas not listed above?

What would you like me to know about you?

For Returning Youth:

What do you like about Youth? Favorite activities?

What areas are there for improvement for "Youth" / Steadfast? Any youth night ideas?

Upload a Current Photo of the Youth for the Youth Board

Upload your file

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Signature Section

To be signed by the Parent/Guardian

Your Signature

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