This information is collected under the authority of the Freedom of Information and Protection of Privacy Act. The information you provide will be used solely to provide
appropriate care for your child and/or to contact you in the event of an emergency.
Does your child have any allergies or medical conditions we need to be aware of? (Please Explain)
Is your child bringing any medication with him/her? (antibiotics, ventilator, Ritalin, etc?)
Please explain any instructions to staff regarding these medications. Staff are not permitted to administer medication. Does your child have any physical, emotional, mental or behavioral concerns or limitations that our staff should be aware of? Please explain.
In the event that your child requires professional medical treatment, we will attempt to notify you immediately. Please enter below participant's AHC number.
Your child must be covered by Provincial Health Insurance or equivalent medical insurance.
Your child will be cared for as if he/she was our child. Every precaution is taken for the safety and well being of your child. Even with normal activities there are certain risks involved. I understand and accept these potential risks, and, by checking the box below, I am bound to release forever Clive Baptist Church all the individuals associated with it, from any and all liability for injury or damage which may be sustained by the guardian and/or child of the guardian, or property of the same at or in transit to or from any church activity. In case of surgical emergency, I hereby give permission to the physician selected by Clive Baptist Church to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery for my child on this form.
Please Note: Clive Baptist Church is not responsible for the above risks for any friends of your child that choose to attend an event. Please secure extra forms from Clive Baptist Church to give to parents of friends prior to an event.
I am aware that photographs from this event may be posted on Clive Baptist Church's Website and Facebook page, by Clive Baptist Church staff. No inappropriate photographs will be posted. Please call our office at 403-784-3335 for more information.
In the event of inclement weather causing need for kids to be transported to a safe location, coaches will transport kids to Clive Baptist Church in private vehicles or by supervised walking. Parents that would like to transport their own kids in weather situations, need to notify the coaches and be present at the soccer field.
I give Clive Baptist Church designated volunteers, permission to transport my child to Clive Baptist Church if inclement weather occurs.
Please Note: Shirt size may vary depending on Availability. We will try our best to match the size chosen. Please select only one box.