ALBC Youth Crew Registration

Youth Registration Form

This registration form is to be filled out by the Youth's Parent or Legal Guardian. Youth, in our ministry is anyone from age 12 until they graduate grade 12. Please contact us if your child is not within these ages or if you have questions at youth@albc.ca.
Youth Information
Name of Youth*
First Last
Date of Birth of Youth*
Mobile Phone Number of Youth
Email of Youth
Enter Email Confirm Email
Youth - Preferred Contact*
Primary Address of Youth*
Street Address Address Line 2 City Province Postal Code
Parent/Guardian Information
Name of Parent/Guardian (Primary Contact)*
First Last
Phone Number of Parent/Guardian (Primary Contact)*
Email of Parent/Guardian (Primary Contact)*
Enter Email Confirm Email
Parent/Guardian Preferred Contact*
Name of Parent/Guardian (Alternate Contact)
First Last
Contact info of Parent/Guardian (Alternate Contact)
Please include contact numbers and email address
Emergency Contact Information
Emergency Contact Name*
First Last
Emergency Contact Relationship to Youth*
Emergency Contact Phone Number

Medical Information
Youth Manitoba Health Number (6 Digit)*
Youth Manitoba Health Number (9 Digit PHIN)*
Medications, Allergies and Dietary Needs/Restrictions*
Please List all Medications and Allergies and dietary needs of the Youth. *Type "none" if not applicable.
Medications Youth carry with them*
Please list any medications that will be brought to or administered at any Youth Meeting time. Type "none" if not applicable.
Transportation
I hereby give permission for my son/daughter to participate in youth activities or events that require transportation to a location away from Abundant Life Baptist Church. I understand that the activity or event will take place under the guidance and supervision of adult youth leaders and/or volunteers from ALBC and that drivers will have valid licences and insurance for the vehicles they are operating.*
After a Youth event, to get home, my youth can/will....*
List allowable forms of transportation: For example, walk, bus, picked up, etc.
Youth Outings
We regularly go on youth outings which will be detailed on the website calendar when possible and invite by email. There are also times we may spontaneously go out on a Youth evening but will return before pick up time. *In the event of a "Spontaneous" outing we will ask the Youth to contact their Parent/Guardian.
I agree that my youth may attend pre-arranged outings posted on ALBC website Calendar or email
I agree that my youth may attend spontaneous outings on the Youth evenings (will return before pick up time or arrangements will be made to drop off youth)*

Social Media, Video/Photograph Release, Additional Involvement
I hereby give permission for my son/daughter to participate in the variety of social media (Twitter, Instagram, Facebook, etc.) options of the Abundant Life Baptist Church Youth Group.*
At various time throughout the year, photographs and/or videos may be taken at the events that the youth take part in. I hereby give permission for photographs of my son/daughter to be used solely for the purposes of Abundant Life Baptist Church and it's Youth Ministry.*
I grant permission for the above named youth to help in different ministries with Abundant Life Baptist Church, as interest and possibilities permit.*
Medical Treatment Authorization and Release of Liability
Medical Treatment Authorization: In the event that my son/daughter requires special medical treatment during his/her participation in the ALBC youth program, including transportation to and from events/activities, I the parent/guardian will be notified immediately. If all reasonable attempts to contact me have been unsuccessful, I hereby consent and give my permission to the physician(s) and any other medical personnel selected by the adult youth leaders or volunteers at Abundant Life Baptist Church to hospitalize, secure proper medical treatment for, and/or to order x-ray examinations, injections, anesthetics, surgery or dental diagnosis for my child as named above which may in their discretion be necessary. Release of Liability: It is my understanding that in participating in the programs or activities in the Abundant Life Baptist Church Youth Ministry is a privilege. I hereby give permission for my son/daughter named above to participate and engage in the activities of Abundant Life Baptist Church Youth Ministry. Abundant Life Baptist Church (including the adult youth leaders and volunteers) will not be held liable for any personal valuables lost or stolen at any youth event. I further release Abundant Life Baptist Church and its employees, adult youth leaders and volunteers from any and all liability claims arising from my son's/daughter's participation in its activities and programs, or as a result of accident, injury, illness or wrongful death caused by negligence or any other cause of my son or daughter during such activities. I represent that I am the parent/guardian of the youth named above, who is under 18 years of age. I fully understand that the consequences of and agree to the Parental Consent & Liability Release form knowingly freely and willingly.

ALBC Youth Crew Registration

Youth Registration Form

Youth Information

Parent/Guardian Information

Emergency Contact Information

Medical Information

Transportation

Youth Outings

Social Media, Video/Photograph Release, Additional Involvement

Medical Treatment Authorization and Release of Liability