Love, Joy, Peace...
Nursery Registration Sep 2021 - Aug 2022

Form Information - Please complete this form for each child.

If you are signed in to Church Connect, there are less fields to complete. :-)

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. On some Sundays we have percussion instruments that they play along with! Halfway through the service, the children aged 3 and older will be dismissed to go downstairs for more singing and a lesson geared towards their age. The children who are younger than 3 are invited to use the nursery at the back of the sanctuary accompanied by a parent/guardian. All children participating in a youth program 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.

Information received is confidential and is being gathered for the purposes of serving your child 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 child in our programs, to assign the child to appropriate classes, to develop and nurture ongoing relationships with you and your child, 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 Options:

I have read, understood and agree with the above and sign it to cover all youth program activities for the program year indicated above.

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)
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 student in any or all of the following ways: printed material, online, video (Required)
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