EGCC Student Registration Form 2019/20

Child's First Name *

Last Name *

Nickname

Street Address *

City / Town *

Postal Code *

Home Phone *

Cell Phone

Parent's Email (For weekly notifications & upcoming events)

Student's Email (If different/separate from parent's email)

Birthdate *

Day *

Year (yyyy) *

Age *

Grade In School *

Mother's Name

Father's Name

Brothers & Sisters

Health Information:

Allergies? *

Yes

No

If YES, please explain

Are any of these allergies potentially life threatening? *

Yes

No

If YES, please explain any further instructions *

Does your child carry / require an EPI Pen? *

Yes

No

If YES, please explain any further instructions

Does your child have any physical, emotional, mental or behavioural concerns or limitations that our staff should be aware of? *

Yes

No

If YES, please explain *

Please review the following items and check all that apply to your child / student:

1. Photography / Videotaping

As part of our activities at EGCC, photos & videos are regularly taken during programs & events and may be posted on our one of our ministry social media pages. All social media pages for children 12 yrs and under are monitored closed accounts and access is restricted to the students and their families, and all names/identities of children will be kept confidential.

Permission to use pictures of the above named child: *

2. Social Media

As part of our ongoing programs, student small groups often use Social Media as a means of communication and group relationship building. Our policies dictate that this is only to be used with students ages 13 & older, and only as it relates to the individual small group's activities. Our policies also require parental permission for such.

Permission for the use of Social Media (including pictures) of the above mentioned student as it relates to their small group and its activities. *

3. Sunday Child Dismissal

We believe it is important for our children to experience part of the Sunday Gathering as part of the greater EGCC family. As such, they are dismissed from the main gathering following worship, limiting the sign-in possibilities. Children are released from the main gathering as a group, accompanied by the EGCC approved Children's Ministry Team, to attend the children's activities.

I understand and give my permission for the above mentioned child to be released from the main gathering during Sunday gatherings. *

All reasonable precautions are taken to ensure the safety and health of your child while attending our programs. In the event of an accident or sickness requiring medical attention, Essex Gospel Community Church, and it's staff & volunteers, are hereby released from any liability. In the event that any child requires special medical attention, medication, x-rays or treatment, the parents/guardians listed above will be notified immediately.

Essex Gospel Community Church will not be responsible / liable for any loss or damages to personal items brought to our programs.

Signature of Parent / Guardian *

clear

Parent's/Guardian's Name *

Relation (if not parent) *

Date * +