Love, Joy, Peace...

Form Information - Please complete this form for each child.

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Kids in the Word - age 3 to Grade 5 - Sundays

Our church is a church family. In a family, children learn from adults, so we model our worship to our children and include them in the first half of our worship service. Halfway through the service, the children will be dismissed to go downstairs for a large group activity and then a small group lesson geared towards their age. This time is called Kids in the Word and all children participating are required to have this permission form filled out in order to participate. Additionally it needs to be renewed each September when the program kicks off again for the year.

Youth Group - Grade 6 to Grade 12 - Thursdays @ 7pm - 9pm

We have a Youth group that meets weekly. All students age 17 and younger are required to have a permission form filled out in order to participate. Additionally it needs to be renewed each September when the program kicks off again for the year.

Please note that for the safety of our youth we ask that parents arrange transportation to and from Youth Group beforehand. 

Confidentiality:

Information received is confidential and is being gathered for the purposes of serving your student while in the care of the church. Any medical information collected here serves to authorize Portage Avenue Church and its personnel to obtain medical assistance in emergencies. This form should be completed annually by a parent/guardian.

Purposes and Extent:

Portage Avenue Church is collecting and retaining this personal information for the purpose of enrolling your student in our programs, to assign the student to appropriate classes, to develop and nurture ongoing relationships with you and your student, and to inform you of program updates and upcoming opportunities at our organization. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish the church to limit the information collected, or to view your student's information, please contact the church office.

Parent / Guardian Consent:

I have read, understood and agree with the above and sign it to cover all youth program activities for the program year September 2024 to August 2025. A separate Informed Letter of Consent will be sent home for activities of elevated risk.

Parent(s)'s Names (Required)
Home Phone#
Cell Phone # (Required)
(type "N/A" if you do not have one)
Parent(s)'s Email (Required)
I give Portage Avenue Church permission to contact me via email (for upcoming events/special announcements) (Required)
I would like the Weekly Update email (sent on Fridays). (Required)
Address (Required)
Street address, City, Province, Postal Code
In case of emergency, contact (Required)
(Example: Uncle Joe, 204.222.2222)
Child's Name (Required)
Child's Birthday (Required)
Which program? (Required)
Kids in the Word (age 3 to grade 5)
PAC Youth (grade 6 to grade 12)
Child's Health Card Number (Required)
Enter "none" if one has not yet been assigned. Enter "later" if you will email us the number later.
Allergies? (Required)
Enter "none" if there are none.
Is there any physical, emotional, mental, behavioural concerns or limitations that personnel should be aware of? (Required)
Enter "none" if there are no concerns.
Is there any medication being brought with him/her? (Required)
Enter "none" if this does not apply.
Photos: I grant permission for the reasonable use of pictures containing my child/student in any or all of the following ways: printed material, online, video (Required)
Does the Youth student have an email / cell phone? (Required)
Please enter the email and/or cell phone # or "none".
I grant permission for personnel to communicate with my Youth student via telephone, email, social media and text within the parameters of the Safe Place Policy. (Required)
I understand that it is the parents' responsibility to arrange for their Youth student's transportation to and from Youth events beforehand. (Required)
According to our insurance's Safe Places policy, youth leaders are unable to drive youth students home.