MB Kids Club Fall 2022 - Winter 2023

• Student Information
• Child's Name*
  First Name

  Last Name
• Child's Birth Date *
  MM

  /

  DD

  /

  YYYY
• Age*
• Grade
  SK

  1

  2

  3

  4

  5
• School Attending/Homeschooling
• Health Information
• Allergies
• Are any of these life threatening?
  >YesNoN/A
• If yes, please explain:
• Does the student have any physical, emotional, mental or behavioral concerns or limitations that our staff should be aware of?
  >YesNoN/A
• If yes, please explain:
• Parent/Emergency Contact Information
• Parent / Guardian*
  First Name

  Last Name
• Parents Phone Number
   

  (###)

  -

  ###

  -

  ####
• Parents e-mail *
   
• Emergency Contact Name
  First Name

  Last Name
• Emergency Contact Number*
   

  (###)

  -

  ###

  -

  ####
• Acknowledgment
• As part of our activities at Meadow Brook Church, photos are often taken during the events of children. We require your permission to use them in any of our publications (i.e. flyers, posters, slideshows, etc.). All names/identities of children will be kept confidential, and will not be shared with any third party (i.e. another church, newspaper) without further written consent.
• Please check all that apply:
  Permission granted to use pictures of above mentioned child for IN-HOUSE productions and advertisements.

  Permission granted to use pictures of above mentioned child for EXTERNAL productions and advertisements.
• All reasonable precautions are taken for the safety and health of your child, but in the event of an accident or sickness requiring medical attention, Meadow Brook Church, and its volunteers are hereby released from liability. In the event that your child requires special medical attention, medication, x-rays or treatment, the parents/guardians will be notified immediately.
• I give permission for my child to participate in the weekly MB Kids Club activities and events. I agree that they will act in accordance with the rules of Meadow Brook Church and its Leadership.*
  I agree
• Your Name *
  First Name

  Last Name
• Date *
  MM

  /

  DD

  /

  YYYY
• Are we able to contact you further regarding upcoming events?
  Yes
• At Meadow Brook we are so excited to welcome all children as they get to know Christ through our Children's Ministry! If you have any questions regarding our various programs, please contact our Child and Youth Director at renee@meadowbrook.ca
• CHECK US OUT ON FACEBOOK AT "MB KIDS CLUB at MEADOW BROOK CHURCH"