Welcome!

We are thrilled to have your child join us in Children's Ministry! To ensure a safe and nurturing environment for all children, please complete this form thoroughly. All information will be kept confidential.

Last name*

First name*

Birthday

Gender*

Male

Famale

Grade Level: (If applicable, e.g., Pre-K, K, Grade 1, etc.)*

Are there siblings attending the church?

Yes

If yes, please provide sibling's name(s) and grade(s).

Parent/Guardian Information

Last Name*

First Name*

Relationship to Child*

Primary Contact Phone Number*

Email*

Address

Health & Special Needs

This information is crucial for your child's safety and well-being. Please be thorough.

Allergies:

Yes

If yes (Please describe and specify reactions/treatment needed):

Medical Conditions:

None

Yes

If yes (Please describe, e.g., Asthma, Diabetes, Epilepsy, etc., and any special care needed):

Special Needs/Behavioral Considerations:

None

Yes

If yes(Please describe any specific needs or considerations that would help our staff best care for your child, e.g., learning style, emotional support needs, sensory sensitivities, etc.):

Authorization and Consent

Please read carefully and initial each statement you agree to.

Please read carefully and initial each statement you agree to.

Emergency Medical Authorization: I hereby authorize the Children's Ministry staff of (Church on the Rock) to seek necessary medical attention, including but not limited to calling an ambulance or transporting my child to a medical facility, in the event of a medical emergency. I understand that all medical expenses incurred

Photo/Video Release Consent: I grant permission for photos or videos of my child to be used for promotional purposes by Church on the rock (e.g., church website, social media, presentations, etc.). (If you do NOT consent, please inform a staff member.)

Behavioral Guidelines: I understand that children are expected to follow the Children's Ministry behavioral guidelines for a safe and positive environment. Staff will provide age-appropriate guidance and discipline as needed.

Signature*

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burnabybaptistchurch@gmail.com

4304 Parker St. Burnaby, Canada BC V5C 3C5

Tel: 236-966-0022