Page 112 | Portage Avenue Church

Trailblazers Registration Sept 2025 - Aug 2026

Please complete this form for each student you are registering.

Our Trailblazers group (grade 7 to grade 12) meets weekly here at the church on Thursdays from 7pm to 9pm. 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 Trailblazers 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 2025 to August 2026. 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)

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.

Solve 4 + 8 = ?

Portage Avenue Church

1420 Portage Avenue
Winnipeg, MB R3G 0W2

churchtrac