Registration Form

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7/8 Youth Registration Form

(formerly known as T.E.A.M.)

Child’s Name _____________________________________________

Home Phone _____________________

Address _________________________________________ City _________________Postal Code____________ Date of Birth M___D____Y______ Age____________ School Grade _____________ Gender M / F (circle one) Name of School _______________________________________________________ Father’s Name _________________________________ Mother’s Name _______________________________ Father’s Cell Phone ______________________________Mother’s Cell Phone ___________________________ Home Email address ___________________________________________

PARENTS’ OR GUARDIANS’ CONSENT:

I___________________________________________ the parent of ________________________________________ consent to his/her participation in the club programs by Calvary Baptist Church. I understand that by permitting my child to be included in this program, I agree that Calvary Baptist Church and anyone acting on its behalf, will be released from any liability for injuries to my child that may be occasioned on this activity and that I give permission to the leaders of this group at Calvary Baptist Church to make decisions in case of an emergency on behalf of my child when I am not immediately available for consultation. (We will try everything possible to contact you, in case of emergency.)

Signature of Parent or Guardian: ____________________________________ Phone home: ____________________ Cell: ____________________________

Emergency contact person: _____________________________________________ Phone: ____________________ Note: (OTHER THAN PARENTS)

Special Health Needs (i.e. allergies, asthma, diabetes, etc.) ________________________________________________

_______________________________________________________________________________________________

Special behavioural / emotional / physical needs. Please explain: __________________________________________

_______________________________________________________________________________________

Church Affiliation ____________________________________ Were you registered last year?

Yes

or

No

(please circle one)