Kid's Club Registration and Consent Form
Information received is confidential and is being gathered for the purposes of serving your children while in the care of Arrowsmith Baptist Church. Any medical information collected here serves to authorize Arrowsmith Baptist Church, and its Staff and Volunteers, to obtain medical assistance in emergencies. This form should be completed annually by the Parent/Guardian/Care Giver.
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Email *
Student Name: *
Student Date of Birth: *
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What grade is your child going into for the school year 2023/2024?
Address
Home Phone Number:
Cell Phone Number:
Email address
yourname@emailaddress.com
Health Card Number
Family Doctor
Allergies
Please list any/all allergies
In case of emergency, contact:
Name and phone number
Who is authorized to pick up your child? (Must be 16 years or older) In case of custody agreements, please include the proper authorizing parental contacts. 
Does your Child have any physical, emotional, mental, or behavioural concerns or limitations that staff should be aware of?
If yes, please explain:
Is your child bringing any medication with him/her?
Clear selection
If yes, please list:
The safety of your child is our primary concern. Precautions will be taken for their well-being and protection. 

I/we, the Parents or guardians named below, authorize an Arrowsmith Pastor or one of Arrowsmith
Baptist Church’s Kid's Club 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 named above.

I/we, named below, undertake and agree to indemnify and hold harmless  Kid's Club
Personnel, Arrowsmith Baptist 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 Arrowsmith Baptist
Church, as well as of any medical treatment authorized by the supervising individuals representing
Arrowsmith Baptist Church.  This consent and authorization is effective only when participating in
to events sponsored by Arrowsmith Baptist Church.

Kid's Club Care Policy & Parental Agreement:
Arrowsmith Baptist Church believes in excellence in our entire Children/Student Ministry Department.  It
is always our endeavor to care for your child(ren) to the best of our ability while they are
entrusted to us.  At any time, we reserve the right to not admit your child into the classroom
should there be signs of any communicable disease or sickness i.e. colds etc. Please ensure
complete information regarding allergies/special needs is provided and updated as needed. Your
child(ren) will only be released to the parent/guardian and/or those whom you have authorized
above.  
I agree with and will abide by this policy. *
Must be signed by parent/guardian.
Photos* *
Please submit a photo of your Child to the office and sign below to grant permission for the reasonable use of pictures containing your Child in any or all of the following ways:
*May be used for identification or in other promotional materials for church use. I acknowledge that these photographs will be stored on the Arrowsmith Baptist Church office computer for these purposes. 
Required
Purposes and Extent

Arrowsmith Baptist Church is collecting and retaining this personal information for the purpose of enrolling your Child in our programs, assigning the student to the appropriate classes, developing and nurturing ongoing relationships with you and your child, and informing you of program updates and upcoming opportunities at our church. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish Arrowsmith Baptist Church to limit the information collected, or to view your child's information, please contact us.  
Parent/Guardian Options

I have read, understood, and agree with the above and sign it to cover all Kid's Club activities for the program year effective as stated below.
 *
Parents'/Guardian Signature
This permission form is effective: DATE 09/01/2023 to 08/31/2024
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