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Participant Registration

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Douglas Mennonite Church

Location

1517 Rothesay Ave

Winnipeg, MB R2G 3G5

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Contact Tobia Veith:

204-668-7432 ext 229

office@douglasmc.ca

First, Tell Us About Yourself:

Parent Information

Information received is confidential and is being gathered to serve your child/youth while in the care of the church. Any medical information collected services to authorize the church and its ministry personnel to obtain medical assistance in emergencies. This form should be completed annually by the parent/guardian.

First Name

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Last Name

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Address 1

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Address 2

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City

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State/Province

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ZIP/Postal Code

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Country

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Contact Phone 1

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Contact Phone 2

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Emergency Contact Name

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Emergency Contact Relationship

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Emergency Contact Phone

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Click here for your FREE Friends With God Kids Activity Pack

By checking the box you will be emailed your Free Friends With God Kids Activity Pack.

You are also agreeing to receive emails about family resources from Lifetree. You can unsubscribe at any time. We value your privacy. Your information will not be shared with a third party. Lifetree is a division of Group Publishing, the creators of Group VBS and other faith-building resources. Click to learn more about Lifetree.

Tell Us About Your Participant

First Name

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Last Name

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Grade Entering

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Gender

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Date Of Birth

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Allergies

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Medical Concerns

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Parent/Guardian Permission:

I have read, understood and agree with the above and sign it to cover all child/youth program activities for the program year effective as stated below. A separate Informed Letter of Consent will be sent home for activities of elevated risk.

Purpose and Extent:

The church is collecting and retaining this personal information to enroll your child/youth in our programs, to assign him/her to the appropriate classes to develop and nurture ongoing relationships with you and your child/youth, and to inform you of program updates and upcoming opportunities at our organization. This information will be maintained indefinitely as a requirement of our insurance company and legal counsel. If you wish the church to limit the information collected, or to view your child's/youth's information, please contact the church office.

Does your child/youth have any physical, emotional, mental, behavioural concerns or limitations that ministry personnel should be aware of?

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Is your child/youth bringing any medication with him/her?

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If yes, please list:

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I/we, the parents/guardians named below, authorize one of the church's ministry personnel to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant above.

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I/we, named below, undertake to agree to indemnify and hold harmless ministry personnel, the church, 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 the church, as well as any medical treatment authorized by the supervising individuals representing the organization. This consent and authorization is effective only when participating in or traveling to events sponsored by the church.

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Communication: A policy is in effect that communication is used solely for the dissemination of information. Please sign below to grant permission for ministry personnel to communicate with your child/youth via telephone, email, social media, and text within the parameters of the “Safe Place Policy”.

Multiple selections are allowed.

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Photos: Please sign below to grant permission for the reasonable use of pictures containing your child/youth in any or all of the following ways:

Multiple selections are allowed.

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Parent/Guardian Signature

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Date

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This permission form is effective from September 2024 to June 2025.

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