Emmanuel Alliance Church of Ottawa Children’s Ministry Registration and Consent Form (September 2023 -August 2024)
Information received is confidential and is being gathered for the purposes of serving your Child while in the care of Emmanuel Alliance Church (EACO) activities. Any medical information collected here serves to authorize Emmanuel Alliance church of Ottawa, and its Staff and Volunteers, to obtain medical assistance in emergencies. This form should be completed annually by the Parent / Guardian.

Please complete ONE FORM FOR EACH CHILD

This consent form is effective: September 1, 2023 to August 31, 2024 for Children from birth to entering Grade 6 in September 2023.
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Email *
Name of Child (First/Last name)
 *
Date of Birth: Day / Month / Year *
Grade (starting September 2023)
 *
Age *
Gender
 *
Required
Home Phone Number *
Home Address (address, city, postal code) *
Name of Parent / Guardian *
Contact Email Address *
In case of emergency, who should be contacted? (Name, phone number, relationship to child) *
Does your child have any physical, emotional, mental, behavioural concerns or limitations that our staff should be aware of? *
Required
If yes, please explain
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