Clubs Registration 2025-2026

Under "your name", please write your name as parent/guardian, and you will fill in child(ren)'s name(s) below under household members.

Please note that we a have limited space in our program, and this is dependant on how many volunteers are able to help. This registration lets us know you are interested, but does not guarantee your child in our clubs program. A separate email of acceptance will follow once our volunteers are in place.

Your name *

Email address *

Phone number *

Household members

Please add all children that plan to participate in Kids Clubs this year. Please also add other parent (if applicable).

Emergency Contact Name *

Please add a second name to contact if we cannot reach parents.

Phone Number for Emergency Contact *

Child Supports *

Make sure to note any other health concerns not listed under medical. Please also mention if your child requires extra support of any kind including if they have an EA at school, have sensory sensitivities, are new English speakers, etc. If not, mark "NONE".

Are you comfortable with the potential for your child’s face appearing on our church’s website or instagram page? *

Yes

I understand that participation in activity involves a risk of accidental injury despite all safety precautions. *

Therefore, I will assume all risks (injury or illness) that may occur during participation in clubs at the Blumenort Community Church (BCC). In case of sudden injury or illness, I herby give authority to any hospital or doctor to render immediate aid as may be required at the time for my child’s health and safety. I understand medical expenses are my responsibility. I acknowledge that I am aware of the potential risk for participating in activities and programs at BCC and agree in no way to hold the BCC or any volunteers liable for any injury that my child may sustain or illness they may contract.

I agree

Signed, *

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