Program Registration | Westburne Alliance Church

Name (Required)

Email Address (Required)

Personal Information

Student's Name (Required)

Date of Birth (Required)

My child is interested in attending: (Required)

Please check the program(s) your child is interested in attending

Kids Church (JK-Grade 5) - During Sunday Service

Kids Club (Grades 1-4) - Thursdays 5-6:30pm (starting Sept 11)

Junior Youth (Grades 5-8) - Thursdays 7-8:30pm (starting Sept 11)

Elevate (Grades 6-8) Every other Sunday 11:45am (starting Sept 7)

Foundation (Grades9-12) Every other Tuesday 7-9pm (starting Sept 9)

Your Address (Required)

Parent Phone Number (Required)

Emergency Contact (Required)

In the event of an emergency, besides yourself, who do we contact? Please provide name and phone number?

Who do you authorize to sign-out your child from events and activities? (Required)

Please provide the person's full name. We will only release a child into the care of a named person.

Do you permit your child to sign themselves out of events and activities?

Only for young people aged 12 years and older. Only with permission of the parents, young people can sign themselves out and leave the premises.

Medical Information

Does you child have any allergies we need to be aware of? (Required)

If yes, please explain:

Does your child have any physical, emotional, mental, behavioural concerns or limitations that we should be aware of? (Required)

If yes, please explain:

Will your child bring any medication with them?

If yes, please list:

Permissions

I, the Parent / Guardian, authorize the Ministry Personnel of Westburne Alliance Church to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures my child in event of an emerge (Required)

I, the Parent / Guardian, undertake and agree to indemnify and hold harmless Ministry Personnel, the Church, and its Leaders from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Westburne Al (Required)

A policy is in effect that communication is solely for sharing information. Please confirm if you consent to Ministry Personnel communicating with your child via any of the following methods.

This only applies to children and youth aged over 12 years. Communication is only for sharing of information.

Phone call

Social media

Email

Text message

I, the Parent / Guardian give permission to have identifiable photos / videos to be taken of my child and to allow Westburne Alliance Church to use these for updates and promotions pertaining to kids activities. (Required)

Note: By registering your child for the event, permission is assumed for non-identifiable images (i.e. group shots) to be used for digital content such as on the Westburne website and social media channels.

I understand that the above applies to all children and youth programs throughout the program year (September 2025 to August 2026). A separate Letter of Informed Consent will be sent home for off-site activities and activities of elevated risk. (Required)