Junior Youth & Youth Registration & Consent Form

The person completing this form must be at least 18 years of age.

Information collected is confidential and will be only used for the purposes of registering your children for Harvest City Church’s activities, and will not be shared with any third party.

This information will be maintained permanently as it is a requirement of our insurance company and legal counsel. If you wish Harvest City Church to limit the information collected, or to view your youth’s information, please contact us.

If you select the 'Other' option, please provide details in the space provided.

Register Youth (Also, add any additional parents/guardians to this household)

Click "+ Add adult" to add each adult who resides with you and may bring a youth from your household to an event or program.

Click "+ Add child" to add each youth from 12 to 17 years.

Note: The medical information gathered here serves to assist and authorize Harvest City Church, its staff and/or volunteers to obtain medical assistance in case of emergency.

In the MEDICAL NOTES field, include anything that program leaders should be aware of. Examples: allergies, special needs (physical/emotional/behavioral concerns), and/or emergency medications the child carries with them. Type NONE if not applicable.

Please provide the health card number for your youth in the case of a medical emergency. If you are completing the form for more than one youth, please write the name of each youth next to their corresponding number.

If there are custody issues, choose "Other" and give a brief explanation.

List anyone who is NOT permitted to drop off and/or pick up your youth.

Parent/Guardian Consent

"I give permission for Harvest City Church to use any photographic, audio or video recording of my youth for identification, security, promotion, or any Harvest City Church use. I acknowledge that these photos and/or recordings will be stored on the Harvest City Church computer system for these purposes. I understand my consent is valid indefinitely unless I in writing notify Harvest City Church that I revoke my consent or request removal of photos, recordings, or personal information from Harvest City Church sites or publications prior to their publication. I further release and hold harmless Harvest City Church from any and all liability that may result from the release and/or use of the above-mentioned information."

*Select 'Other' if you have more than one youth on this form and consent differs.

Harvest City Church believes in excellence in our entire Children’s & Youth Ministry Departments. It is always our endeavour to care for your youth to the best of our ability while they are entrusted to us. Their safety is our primary concern; precautions will be taken for their well-being and protection. However, we do assume responsibility for the care only when complete information regarding allergies, any other special needs, etc. is provided. That’s why we require that you submit this form.

If your youth’s situation changes for any reason, please ensure that the changes are communicated directly to the leaders in charge of the event they are attending. At any time we reserve the right to not admit your youth into a event if there are signs of any communicable disease or sickness (e.g. colds), etc.

We reserve the right to ask individuals to leave who exhibit extreme or rebellious behavior that negatively impacts our ability to care for the group in its entirety.

I/we, named herein, authorize Harvest City Church's pastors or other program personnel to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment, or procedures for the youth named above.

I/we, named herein, undertake and agree to indemnify and hold harmless Harvest City Church, it's program personnel and leaders from and against any loss, damage, or injury suffered by the youth named above as a result of being part of the activities of Harvest City Church, as well as of any medical treatment authorized by the supervising individuals representing Harvest City Church. This consent and authorization is effective only when participating in or traveling to or from events sponsored by Harvest City Church.

For a youth to participate in Harvest City Church activities, at least one Parent or Guardian with permission to care for them must agree below.

By typing your full name you are indicating you have read and agreed to all of the above, and the information you have provided is true to the best of your knowledge.