Child Attending *
First and Last Name
Primary campus *
Select… Arabic Site Brant Site Cambridge Site Church at Home Kitchener Site
What grade is the child in?
* If filling this out in the Summer, please select which grade the child is going into.
Select… 7 8 9 10 11 12
I give permission for my child to participate in all events sponsored by The Student Ministries of Forward Church from Sept 01, 2025- Aug 31 , 2026
Liability *
In consideration of the attendance of my child at the activities with Student Ministries at Forward Church. I do hereby release and discharge Forward Church and all its directors, sponsors, and adult leaders acting officially or otherwise, from any and all claims, demands, actions, or causes of action on account of injury sustained by my child in these activities.
Select… yes no
Medical Treatment *
I authorize any directors, sponsors, or adult leaders of Forward Church to obtain emergency medical treatment for my child at any time during these activities. I understand that every effort will be made to notify me of any injury to my child before any treatment is administered. In the event that I cannot be reached, I give permission for my child to be evaluated, diagnosed, treated and or medicated by licensed medical personal. In addition, I grant permission for the release of any medical information which I gave Forward Church to be given to medical personnel in case of illness.
Select… yes no
Photo Consent *
I also recognize that Forward Church may use photography and video images of events in publicity materials such as websites, social media, newspaper, videos, and posters and I, therefore, grant permission for photo/video images of my child to be taken and used for such purposes.
Select… yes no
Transportation *
I agree to be responsible for my child’s transportation home, including in the event of disciplinary action that warrants it necessary for the dismissal of my child from any of these activities upon being notified by the adult leader/youth director. Should it be deemed necessary for my child to return home for these activities due to medical reason, disciplinary action or otherwise, I will assume all transportation costs.
Select… yes no
Acknowledgement of Terms *
I acknowledge that I have read the foregoing Liability Release Waiver and understand its contents; and fully competent to give my consent for my child to participate in the activities of the Student ministries of Forward Church; that I have been sufficiently informed of the risks involved and give my voluntary consent in signing it as my own free act and deed; that I give my voluntary consent in signing this Liability Release Waiver as my own free act and deed with full intention to be bound by the same, and free from any inducement or representation.
Select… yes no
Confirmation/ Agreement of the above Terms and Conditions *
Please type your full legal name below to acknowledge that you have read, understand and agree to the above stated terms and conditions.
Name of Emergency Contact *
First and Last name
Emergency Contact Phone Number *
*including area code
Health Card Number *
*including 2 letter version code
Please list any relevant medical/allergy information
Additional Information
List any information that would be beneficial for the Forward Youth Staff to be aware of.
Submit A copy of your responses will be sent to your email address.
