Registration Form

Student Information

Name

Sex

Male Female

Birthday

Grade

School

Sacraments

Dedication Baptism First Communion Confirmation None

Allergies/Dietary Needs

EPI-Pen?

Yes No

Medical Conditions, Learning Disabilities, Behavioural

Home Church

Program Registration

Program shirts are given for Ground Zero, Bedlam, and Sr. Youth Group and are included in the fee. Shirts are generally distributed 2 weeks after registration is completed, depending on stock.

Select all programs you will be involved in:

Kids Church (nursery-grade 6) Youth Class (grades 7-12) Ground Zero (grades 1-5) Bedlam (grades 6-8) Sr. Youth (grades 9-12)

Contact Information

Lives With

Both Parents Mother Father Joint Custody Other

Student's Email

This address will receive a confirmation email

Student's Cell Phone

Address

Mother's Name

Mother's Cell Phone

Home Phone

Mother's Email

This address will receive a confirmation email

Father's Name

Father's Cell Phone

Home Phone

Father's Email

This address will receive a confirmation email

Emergency Contacts

Name

Relationship

Phone

Name

Relationship

Phone

Permissions

Permission to take photographs/videos and publish for promotion.

Yes No

Permission to go on supervised short community outings (ie. park, Tim Horton’s, etc.).

Yes No

Permission to share address with local parents of children in the same program to carpool.

Yes No

Permission to walk home alone or with a friend without prior notification to the St. Paul’s staff.

Yes No

Permission to receive a drive. Note: all students under the age of 8 will be required to be in a booster seat if receiving a drive from the children’s and youth ministry team.

Yes No

Permission to share parent/guardian contact information with other ministries within St. Paul's on-the-Hill Anglican Church.

Yes No

This consent form gives permission to seek whatever medical treatment is deemed necessary, and releases St. Paul’s on-the-Hill Anglican Church, its staff and volunteers of any liabilities. In the event of an emergency, if you cannot be reached, the emergency contact will be contacted. In the event that none of the contacts can be reached, a staff member of St. Paul’s on-the-Hill Anglican Church has permission to seek medical attention.

Midweek Program Fees

Ground Zero, Bedlam, and Sr. Youth Group
$35 per child and $15 per additional sibling
Cash or check can be given to program leaders
E-transfers can be sent to spothkidspayment@gmail.com

Parent Signature

Registration Form

Description

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