Broadway Church Registration and Parental Consent Form

Information received is confidential and is being gathered for the purposes of serving your Child/Youth while in the care of Broadway Church. Any medical information collected here serves to authorize Broadway Church, and its staff and volunteers, to obtain medical assistance in emergencies.

In the case of custody agreements, please include the proper form authorizing Parental contacts.

Note: At the beginning of the form, please provide the parent's first and last name in the designated field.

Your name *

Email address *

Phone number *

Primary campus *

Household members

If your child has any allergies, please provide this information in the 'Medical Notes' field.

Address

Is your child bringing any medication with them?

If yes, we will send you a form to be filled out with more details, and our staff will contact you to discuss how we can best support your child.

Does your child have a disability or additional needs?

For example; Autism, Down Syndrome, ADHD, Physical Disability etc .
If yes, please fill out this form with more details, and our Broadway Buddies staff will contact you to discuss how we can best support your child.

Emergency Contact's Name *

This contact will be used if we are unable to reach the parents or guardians in case of an emergency.

Emergency Contact's Phone *

BC Care Card Number

If you have more than one child, enter all numbers separated by ","

Agreement and Consent *

I/we, named below, agree to indemnify and hold harmless Ministry Personnel, Broadway Church, and its Leaders from any loss, damage, or injury suffered by the participant during Broadway Church activities or authorized medical treatment. This consent applies only to events sponsored by Broadway Church. I/we also authorize Broadway Church Staff to consent to medical treatment and allow any physician or hospital to provide necessary care for the participant.
Broadway Church collects and retains personal information to enroll your child in programs, assign classes, build relationships, and provide updates. This information is kept indefinitely as required by our insurance and legal counsel. For limitations or access to your child’s information, please contact us. I have read, understood, and agree to the above, covering all program activities. Separate consent will be sent for off-site or higher-risk activities.

Communication

I consent to receive Broadway Church Next Generation monthly newsletter

You can unsubscribe at any time

Communication with Student 13 years of age and older

A policy is in effect that communication is to be used solely for the dissemination of information. Please check the box below to grant permission for Children/Youth Program Ministry Personnel (staff and volunteers) to communicate with your child via phone, email, social media and text.

Phone

Social Media

Text messages

Volunteers

We need more volunteers to make our ministry great. As a parent, we value your partnership and would love to add you to a team! Even serving once a month makes a huge difference.

Photo/Video Release

Photos/Video of participants are often taken to document and promote our programs.  These photos/video may be used in program brochures, photo displays, and on our Broadway Church website.  We will not release any names or give any other information out regarding the identification of individuals in the photos/video without their prior consent.  This consent form is to obtain permission to use your child’s image ONLY. 

I agree to allow the image/photo/video of my child to be used in printed publications, on Broadway Church’s website, and on Broadway Church’s social media (Facebook and Instagram).

Parent Volunteers

I am interested in volunteering (required to have attended Broadway Church for a minimum of 6 months)

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