Child application Form

Afternoon Adventures is an after school program facilitated by volunteers from First Ave Church for Little Mountain Elementary families with students in grades 3-5. It provides a safe, fun and productive environment for families in need of after school care for their children. Afternoon Adventures runs Wednesdays from 2:00-4:05PM beginning on October 2nd. We’re collecting and retaining this personal information for the purpose of enrolling your child(ren) in our program. More information about Afternoon Adventures is available at the school office, citylifecentre.ca, or by email at info@firstave.org.

Please ensure this whole form is completed no later than September 25, 2019 to secure your child’s spot

Child's Name *
Child's Name
Birthdate *
Birthdate
Parent/Guardian Name(s) *
Parent/Guardian Name(s)
Address *
Address
Home Phone *
Home Phone
Work Phone *
Work Phone
Cell Phone *
Cell Phone
Emergency Contact *
Emergency Contact
In case of emergency, contact the following person (other than parent):
Address
Address
Home Phone *
Home Phone
Work Phone
Work Phone
Cell Phone *
Cell Phone
Pick Up Authorization *
Authorized Pick Up *
Authorized Pick Up
Address
Address
Home Phone *
Home Phone
Work Phone
Work Phone
Cell Phone *
Cell Phone
WAIVER AND RELEASE OF LIABILITY
In consideration of City Life Centre and First Ave Church, including its leaders, volunteers and administrators that have permitted me to attend and participate in this program, I hereby waive all rights which I may now have or which may accrue in the future against the above mentioned parties. I hereby release and discharge them, holding them harmless from and against all liability for any and all action, damages, causes of action, suits, costs, losses, expenses, claims, demands, damages, and judgments which I and my entire family ever had, now have, or hereafter can, shall, or may have resulting from or arising in connection with my involvement with these organizations. I/We as the parents/caregiver/guardian accept the terms of this waiver and release of liability as a condition to my child’s attendance of this program.
Additionally (please check each box): *
Name *
Name
Date *
Date
Signature
OFF CAMPUS ACTIVITY RELEASE CONSENT FORM
We are planning a variety of Afternoon Adventures activities for the 2019-2020 year, of which some will take us off campus and will require your permission prior to participation. As a reminder of upcoming “off campus” activities, your child will receive a letter two weeks prior to the date, informing you about time, place and the kind of activities. There is NO CHARGE for OFF CAMPUS activities to the students and, if needed, transportation will be provided. Since the safety of your child(ren) is our primary concern, we’re requesting that you fill out this one time consent form for off campus activities. This form allows us to include your child(ren) in any of the off campus activities supervised by the Afternoon Adventures Team Leader and Volunteers.
By signing below I agree to the following: I hereby consent to the participation of my child(ren) in the Afternoon Adventures program off campus activities. I understand that my child(ren) will be transported on the bus to and from these school if necessary or may walk to their place of activity. I will not hold City Life Centre, the partnering church, or any Afternoon Adventures Leaders or Volunteers accountable or responsible in the unlikely event that my child(ren) is/are injured while participating during these activities.
Date *
Date
Student's Full Name *
Student's Full Name
Parent/Guardian's Name *
Parent/Guardian's Name
Cell Phone *
Cell Phone
Work Phone
Work Phone
Home Phone *
Home Phone