Child's Name *

First Name

Last Name

Guardian's Name *

First Name

Last Name

Phone *

(###)

###

####

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Secondary Emergency Contact

First Name

Last Name

Second Phone

Secondary Emergency Contact

(###)

###

####

Allergies or Health Concerns *

None

Yes

Do you need bus transportation? *

(If Available in Area)

Yes

No

Waiver *

I have the authority to, and I choose to give permission for the children listed on this registration, waiver, and medical release form to attend the Summer Youth Club at Steel City Baptist Church (SCBC), to participate in all of the activities involved, including, but not limited to: games, sports, services, partaking in food and beverages, and transportation to/from SCBC or any activity. I understand that pictures and video may be taken of my child(ren) and used for social media or promotional purposes. In the case that the volunteers, or staff of SCBC recognize a health situation as urgent, I understand that they may need to authorize medical treatment and release or obtain medical or personal information that may be necessary for the care or treatment of these children. I choose to waive, release, hold harmless, and agree not to sue Steel City Baptist Church located at 92 Parkdale Ave N. Hamilton, ON, L8H 5W9 (including its Pastor, staff, members, volunteers, or affiliates). I verify that the information on this card is true and accurate.

I AGREE