CityWide Kids Summer Splash

Parent/Guardian

Name

This address will receive a confirmation email

Phone

Address

Child 1:

Child's Name (First and Last)

Date of Birth

Grade (as of Fall 2025)

Was your child invited by a friend? If so, who (first and last name)?

Address if different from above. (CityWide Kids send out a little treat in-between events and we wouldn't want anyone to miss out!))

Does your child have any allergies? Will they be bringing any medication with them?

Does your child have any physical, emotional, mental, behavioural or any medical concerns that our volunteers need to be made aware of? Please specify & explain.

Child 2:

Child's Name (First and Last)

Date of Birth

Grade (as of Fall 2025)

Was your child invited by a friend? If so, who (first and last name)?

Address if different from above. (CityWide Kids send out a little treat in-between events and we wouldn't want anyone to miss out!))

Does your child have any allergies? Will they be bringing any medication with them?

Does your child have any physical, emotional, mental, behavioural or any medical concerns that our volunteers need to be made aware of? Please specify & explain.

Child 3:

Child's Name (First and Last)

Date of Birth

Grade (as of Fall 2025)

Was your child invited by a friend? If so, who (first and last name)?

Address if different from above. (CityWide Kids send out a little treat in-between events and we wouldn't want anyone to miss out!))

Does your child have any allergies? Will they be bringing any medication with them?

Does your child have any physical, emotional, mental, behavioural or any medical concerns that our volunteers need to be made aware of? Please specify & explain.

Child 4:

Child's Name (First and Last)

Date of Birth

Grade (as of Fall 2025)

Was your child invited by a friend? If so, who (first and last name)?

Address if different from above. (CityWide Kids send out a little treat in-between events and we wouldn't want anyone to miss out!))

Does your child have any allergies? Will they be bringing any medication with them?

Does your child have any physical, emotional, mental, behavioural or any medical concerns that our volunteers need to be made aware of? Please specify & explain.

Parent/Guardian Permissions

I, the parent or guardian named in this application, authorize the ministry staff of Family Christian Centre to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the child/(ren) named above. I undertake and agree to indemnify and hold blameless the ministry staff and volunteers, Family Christian Centre, its pastors, and Pastor’s Council from and against any loss, damage or injury suffered by the child as a result of being part of the programs of Family Christian Centre as well as of any medical treatment authorized by the supervising individuals representing the church. I have read, understood and agree with the above and sign it to cover my child(ren)’s participation in all Children’s Ministry activities through Family Christian Centre for the 2025 program year effective as stated above.

Yes, I agree No, I do not agree

As the guardian you give consent to the reasonable use of pictures containing the child/(ren) named above in any of the following ways: Brochures, promotional material, church power points, bulletin boards, FCC social media and the FCC website.

Yes, I give consent No, I do not give consent. Option

CityWide Kids Summer Splash

Description

Please Fix the Following