Child's Name *
Child's Name
Birth Date *
Birth Date
Gender *
Address *
Emergency Contact *
Emergency Contact
I give my child consent to participate in Momentum with City View Church. *
The form is needed for your child to participate in Momentum Jr. High Convention with City View Church. You acknowledge that your child has permission to participate in traveling to Oakville, Ontario for Momentum and will be staying overnight at Peel Pentecostal Church in Brampton, ON. All required information is being submitted including postal code and phone numbers. This information will be used to register your child for Momentum, to ensure that your child or student is able to a safe time while with us. Medical: Precautions are taken for the safety and health of your child, but in the event of accident, sickness, City View Church (Royal View Church Inc.), its staff and volunteers are hereby released from liability. If your child requires special medication, x-rays, surgery or other medical treatment, effort will be exercised to contact the person listed on this form. However, if notification is not possible, by signing below you hereby authorize City View Church (Royal View Church Inc.), staff and volunteers to seek medical attention for your child on your behalf. Promotional: Photographs, video and audio are taken weekly at our programs. These media tools are for promotional and educational use only and to share our events with Church and Community. By signing below you authorize City View Church (Royal View Church Inc.), staff and volunteers to photograph, video, record your child for the purpose of advertising and promotions. Rules: By signing below you agree that your child will make every effort to abide by the rules and safely guidelines of the programs, and events at City View Church (Royal View Church Inc.). Should your child refuse to abide by the rules, disrupt programs or other children, they will be removed from the program/activity until they are ready and able to return. If your child repeatedly chooses not to abide by the rules, they will be sent home at the parents expense and asked not to return for a short period of predetermined time. Transportation: By signing below I give my child permission to ride with the group to Oakville/Brampton. Purpose and Extent: City Church is collecting and retaining this personal information for the purpose of of this event (Momentum Jr. High Convention - November 3-4). This information will be maintained permanently as it is a requirement of our insurance company and legal counsel. If you wish City View Church to limit the information collected, or to view your child’s information, please contact us.