Children's Ministry Registration Form

Fill out Section One for each child you wish to register in our Children's Ministries Program. To save you time, if the household information is the same, Section Two is only required once per household.

Kingston Gospel Temple collects information for the purposes of enrolling your child in our programs, developing and nurturing ongoing relationships with you and your children, and to keep you up to date with all that's going on with the Children's Ministries here at KGT. We are required to maintain this information permanently as part of our insurance obligations. If you with to limit the information collected, please contact our church office at 613.548.3855

Registration 1:

Section One:

Child's First Name *

Child's Last Name *

Gender *

Female

Male

Date Of Birth *

Health Card Number and Version Code

Health Card Expiration Date

Does your child have any allergies, medical concerns or special needs? *

Yes

Please list all allergies, medical concerns or special needs:

Please read the following disclaimers and select each that you give consent to:

I give permission for the child named above to participate in the events at Kingston Gospel Temple *

Yes

I give permission for the staff and volunteers of Kingston Gospel Temple to seek medical attention in the case of an emergency *

Yes

In cases of emergencies, I give permission for the child above to be transported as needed by the staff and volunteers of Kingston Gospel Temple *

Yes

I give permission for the child named above to appear in images or videos online or in printed promotional materials as deemed acceptable by the staff and volunteers of Kingston Gospel Temple *

Yes

Section Two: Household Information

Primary Contact (First and Last Name of person who should be contacted first in case of emergency)

Primary Contact Phone Number

Primary Contact e-mail

Relationship to the child

Mother

Father

Other

Secondary Contact (First and Last Name)

Secondary Contact Phone Number

Secondary Contact e-mail

Relationship to the child

Mother

Father

Other

Street Name and Number

City/Town

Province

Postal Code

Yes

Is the household information for the second child the same as the first? *

Yes

Registration 2:

Section One:

Child's First Name *

Child's Last Name *

Gender *

Female

Male

Date Of Birth *

Health Card Number and Version Code

Health Card Expiration Date

Does your child have any allergies, medical concerns or special needs? *

Yes

Please list all allergies, medical concerns or special needs:

Please read the following disclaimers and select each that you give consent to:

I give permission for the child named above to participate in the events at Kingston Gospel Temple *

Yes

I give permission for the staff and volunteers of Kingston Gospel Temple to seek medical attention in the case of an emergency *

Yes

In cases of emergencies, I give permission for the child above to be transported as needed by the staff and volunteers of Kingston Gospel Temple *

Yes

I give permission for the child named above to appear in images or videos online or in printed promotional materials as deemed acceptable by the staff and volunteers of Kingston Gospel Temple *

Yes

Section Two: Household Information

Primary Contact (First and Last Name of person who should be contacted first in case of emergency)

Primary Contact Phone Number

Primary Contact e-mail

Relationship to the child

Mother

Father

Other

Secondary Contact (First and Last Name)

Secondary Contact Phone Number

Secondary Contact e-mail

Relationship to the child

Mother

Father

Other

Street Name and Number

City/Town

Province

Postal Code

Yes

Is the household information for the third child the same as a previous child? *

Same as First

Same as Second

Registration 3:

Section One:

Child's First Name *

Child's Last Name *

Gender *

Female

Male

Date Of Birth *

Health Card Number and Version Code

Health Card Expiration Date

Does your child have any allergies, medical concerns or special needs? *

Yes

Please list all allergies, medical concerns or special needs:

Please read the following disclaimers and select each that you give consent to:

I give permission for the child named above to participate in the events at Kingston Gospel Temple *

Yes

I give permission for the staff and volunteers of Kingston Gospel Temple to seek medical attention in the case of an emergency *

Yes

In cases of emergencies, I give permission for the child above to be transported as needed by the staff and volunteers of Kingston Gospel Temple *

Yes

I give permission for the child named above to appear in images or videos online or in printed promotional materials as deemed acceptable by the staff and volunteers of Kingston Gospel Temple *

Yes

Section Two: Household Information

Primary Contact (First and Last Name of person who should be contacted first in case of emergency)

Primary Contact Phone Number

Primary Contact e-mail

Relationship to the child

Mother

Father

Other

Secondary Contact (First and Last Name)

Secondary Contact Phone Number

Secondary Contact e-mail

Relationship to the child

Mother

Father

Other

Street Name and Number

City/Town

Province

Postal Code

Yes

Is the household information for the fourth child the same as a previous child? *

Same as First

Same as Second

Same as Third

Registration 4:

Section One:

Child's First Name *

Child's Last Name *

Gender *

Female

Male

Date of Birth *

Health Card Number and Version Code

Health Card Expiration Date

Does your child have any allergies, medical concerns or special needs? *

Yes

Please list all allergies, medical concerns or special needs:

Please read the following disclaimers and select each that you give consent to:

I give permission for the child named above to participate in the events at Kingston Gospel Temple *

Yes

I give permission for the staff and volunteers of Kingston Gospel Temple to seek medical attention in the case of an emergency *

Yes

In cases of emergencies, I give permission for the child above to be transported as needed by the staff and volunteers of Kingston Gospel Temple *

Yes

I give permission for the child named above to appear in images or videos online or in printed promotional materials as deemed acceptable by the staff and volunteers of Kingston Gospel Temple *

Yes

Section Two: Household Information

Primary Contact (First and Last Name of person who should be contacted first in case of emergency)

Primary Contact Phone Number

Primary Contact e-mail

Relationship to the child

Mother

Father

Other

Secondary Contact (First and Last Name)

Secondary Contact Phone Number

Secondary Contact e-mail

Relationship to the child

Mother

Father

Other

Street Name and Number

City/Town

Province

Postal Code

Yes

Is the household information for the fifth child the same as a previous child? *

Registration 5:

Section One:

Child's First Name *

Child's Last Name *

Gender *

Female

Male

Date of Birth *

Health Card Number and Version Code

Health Card Expiration Date

Does your child have any allergies, medical concerns or special needs? *

Yes

Please list all allergies, medical concerns or special needs:

Please read the following disclaimers and select each that you give consent to:

I give permission for the child named above to participate in the events at Kingston Gospel Temple *

Yes

I give permission for the staff and volunteers of Kingston Gospel Temple to seek medical attention in the case of an emergency *

Yes

In cases of emergencies, I give permission for the child above to be transported as needed by the staff and volunteers of Kingston Gospel Temple *

Yes

I give permission for the child named above to appear in images or videos online or in printed promotional materials as deemed acceptable by the staff and volunteers of Kingston Gospel Temple *

Yes

Section Two: Household Information

Primary Contact (First and Last Name of person who should be contacted first in case of emergency)

Primary Contact Phone Number

Primary Contact e-mail

Relationship to the child

Mother

Father

Other

Secondary Contact (First and Last Name)

Secondary Contact Phone Number

Secondary Contact e-mail

Relationship to the child

Mother

Father

Other

Street Name and Number

City/Town

Province

Postal Code

Yes

Is the household information for the sixth child the same as a previous child? *

Registration 6:

Section One:

Child's First Name *

Child's Last Name *

Gender *

Yes

Date of Birth *

Health Card Number and Version Code

Health Card Expiration Date

Does your child have any allergies, medical concerns or special needs? *

Yes

Please list all allergies, medical concerns or special needs:

Please read the following disclaimers and select each that you give consent to:

I give permission for the child named above to participate in the events at Kingston Gospel Temple *

Yes

I give permission for the staff and volunteers of Kingston Gospel Temple to seek medical attention in the case of an emergency *

Yes

In cases of emergencies, I give permission for the child above to be transported as needed by the staff and volunteers of Kingston Gospel Temple *

Yes

I give permission for the child named above to appear in images or videos online or in printed promotional materials as deemed acceptable by the staff and volunteers of Kingston Gospel Temple *

Yes

Section Two: Household Information

Primary Contact (First and Last Name of person who should be contacted first in case of emergency)

Primary Contact Phone Number

Primary Contact e-mail

Relationship to the child

Mother

Father

Other

Secondary Contact (First and Last Name)

Secondary Contact Phone Number

Secondary Contact e-mail

Relationship to the child

Mother

Father

Other

Street Name and Number

City/Town

Province

Postal Code

You have reached the maximum number of registrations available on this form. To register additional children, please click the submit button and begin a new form.