CASE Kids Registration Form

Child/Youth Ministry Authorization, Consent & Waiver of Liability Form
**CONFIDENTIAL when completed**

***READ CAREFULLY: By signing this document you are giving up certain legal rights, including the right to sue The Church at South Edmonton Fellowship (“CASE”).
CASE encourages spiritual growth and community for children and youth through age-specific onsite activities and programming (hereafter “Children/Youth Ministry”). Completion of this form and acceptance of the terms and conditions set out below is a condition of your child’s participation in Child/Youth Ministry. The consent and authorization you provide in this document are effective only when your child is participating in or travelling to or from Child/Youth Ministry. Please leave the completed form with the Child/Youth Ministry Director.
CASE collects and maintains the personal information requested below for the purposes of serving your child while in the care of CASE, its staff and volunteers, as well as for enrolling your child in our programs, assigning your child 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. BY COMPLETING AND SUBMITTING THIS FORM YOU ARE AUTHORIZING CASE, its staff and volunteers to make use of and share this information for these purposes.

CASE will maintain this information indefinitely as required by our insurers and legal counsel. If you wish CASE to limit the information collected, or to view your child's information, please contact us by email at:
info@thechurchse.com.

Your name *

Email address *

Household Information

Household Members *

List all the members of your household, first and last name

Address *

Phone number *

Emergency Contact Information

In case of an emergency in which the parents cannot be reached, who should we contact?

Emergency Contact Person's Name: *

Emergency Contact Person's Phone #: *

Relationship to Children *

Medical Information

Alberta Health Care Number *

List all numbers for each child

Family Doctor *

Family Doctor's Phone Number

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

If yes, please explain.

Is your child bringing any medication with him/her? *

If yes, please list the medication(s) and any other relevant information (e.g. dose, frequency, time, reason etc)

Informed Parental Consent and Waiver of Liability

I/We, as the parent/guardian(s) listed above, of the child/children listed above, CONSENT to my/our child’s participation in Child/Youth Ministry (including any transportation to and from Child/Youth Ministry) for the 2023/2024 ministry year AND AUTHORIZE staff and volunteers of CASE to take any action necessary to protect my/our child during Child/Youth Ministry, including but not limited to ARRANGING AND CONSENTING TO EMERGENCY MEDICAL ASSESSMENT, TREATMENT, OR PROCEDURES FOR MY/OUR CHILD as required.
I/We have taken all necessary steps to familiarize myself/ourselves with the nature of the Child/Youth Ministry’s activities and have satisfied myself/ourselves that my/our child’s participation in Child/Youth Ministry is appropriate. I/We understand there are risks inherent to participating in Child/Youth Ministry including but not limited to risks of injury, death or property damage and I/WE FREELY ASSUME ALL RISKS ARISING FROM MY/OUR CHILD’S PARTICIPATION IN CHILD/YOUTH MINISTRY.

I/We represent and warrant to CASE that I/We have the authority to enter into this CASE YOUTH INFORMATION and PARENTAL CONSENT, WAIVER AND INDEMNITY on behalf of my/our child and that the terms and conditions of this agreement bind my/our child and any guardian or representative of my/our child.

PHOTOS, VIDEOTAPING and MEDIA AUTHORIZATION

I/We have reviewed CASE’s Photography Policy and hereby AUTHORIZE reasonable use of pictures containing my/our child in any or all of the following ways: Brochures/Promotional materials, church website, social media, newsletters, and/or videotaping for church promotional purposes.

WAIVER OF LIABILITY and INDEMNITY AGREEMENT

In consideration of CASE allowing my/our child to participate in Child/Youth Ministry, I/We jointly and severally agree:

1. TO WAIVE ANY AND ALL CLAIMS that I/We or my/our child have or may in the future have against CASE (including its pastors, elders, leadership team, employees, ministry personnel and volunteers) arising out of any aspect of my child’s participation in Child/Youth Ministry and TO RELEASE CASE from any and all liability resulting from any loss, damage, expense or injury including death that I/We or my/our child may suffer during my child’s participation in Child/Youth Ministry or resultant medical treatment, DUE TO ANY CAUSE WHATSOEVER, INCLUDING WITHOUT LIMITATION NEGLIGENCE, BREACH OF CONTRACT, OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE, AS WELL AS ANY DUTY OF CARE OWED UNDER THE OCCUPIERS LIABILITY ACT (ALBERTA), ON THE PART OF CASE;

2. TO HOLD HARMLESS AND INDEMNIFY CASE (including its pastors, elders, leadership team, employees, ministry personnel and volunteers):

a) from ANY AND ALL LIABILITY for any damage to the personal property of, or personal injury to or death of, any third party resulting from my/our child’s participation in Child/Youth Ministry;

b) from ANY AND ALL CLAIMS, DEMANDS, ACTIONS AND COSTS which might arise out of my/our child participating in Child/Youth Ministry, even though such claims, demands, actions and costs may have been caused or contributed to by the negligence of CASE.

I/We ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD THIS CHILD/YOUTH AUTHORIZATION, CONSENT AND WAIVER OF LIABILITY before signing it, that I/We have executed it voluntarily, and that it is intended to apply to all CASE Youth Ministry activities including off-site activities and to be binding upon myself/ourselves, my/our heirs, executors, administrators and representatives.

EFFECTIVE FOR ONE YEAR FROM DATE SIGNED.

Date *

Digital Signature *

This is your digital signature.

Grade