What We Believe
Student Registration Form for Student Ministries
Student's Last Name
Student's First Name
Home Phone Number(s)
Student's Cell Number
Student's Email Address
First Parent/Guardian's First Name
First Parent/Guardian's Last Name
Address, if different than above
First Parent/Guardian's Cell Phone
First Parent/Guardian's Email Address
Second Parent/Guardian's First Name
Second Parent/Guardian's Last Name
Address, if different than above
Second Parent/Guardian's Cell Phone
Second Parent/Guardian's Email Address
Student's Date of Birth
Alberta Health Card Number
Allergies - Does this student have any allergies that we should be aware of? Please list them below:
Do you have any special instructions or physical, emotional, mental, or behavioral concerns/limitations for this student that we should be aware of?
How did you hear about REVOLVE Youth?
What church do you attend?
Would you like to be involved with REVOLVE Youth in any of the following areas? (Check all you are interested in.)
Would you like to receive weekly texts with updated REVOLVE Youth information?
If Yes, enter preferred cell number: ______________________________________________________________________________________________________
PERMISSION: Do we have your permission to follow up with your student via text?
INFORMED CONSENT: In the event of an emergency where medical treatment is required, I give permission to the church staff and/or sponsors to obtain services for treatment as deemed necessary if I cannot be contacted in a reasonable amount of time. Further, I will hold harmless or indemnify Gospel Centre Pentecostal Church for any loss or injury that may be sustained. I recognize that there are risks inherent in activities my child may be engaged in and, again, I waive, hold harmless, or indemnify Gospel Centre Pentecostal Church, its instructors, paid or volunteer staff, successors, heirs, and assigns from any action.
WAIVER: I hereby give permission for my child to be photographed and/or filmed without any reimbursement of any kind due to me or the need to pay any fee. Gospel Centre Pentecostal Church considers all information personal and confidential and will only use it within the church for ministry or other church related activities and will not release it to outside parties or organizations.
OFF-SITE PERMISSION: I/We, the undersigned parent(s) or legal guardian(s) for the child named above, give our permission for our child to participate in offsite events between September 14, 2019 and August 31, 2020. We also give permission for any representative of Gospel Centre Pentecostal Church to obtain necessary medical treament asneeded while offsite. We assume responsibility for any medical bills incurred and, should our child have to return home before the grou for medical or disciplinary reasons, we also hereby assume any cost incurred. We give authorization for the previously mentioned to provide all necessary food, transportation, and lodging, as applicable. We do hereby release, forever discharge, and agree to hold harmless Gospel Centre Pentecostal Church, its staff and/or sponsors, and representatives thereof from any and all liability claims or demands for personal injury, sickness, or death, as well as property damage and expenses of any nature whatsoever which may be incurred by our child in the course of participation in the aforementioned. Furthermore, we agree to assume all responsibility for any of the previously mentioned occurrences.
Emergency Contact Name
Emergency Contact Number
Gospel Centre Pentecostal Church considers all personal information as confidential and will not release it to outside parties or organizations. However, by completing this form, you are providing consent for this information to be used within the church for ministry and other church related activities. when using photos of Gospel Centre events, either on our website or on Gospel Centre's Facebook page, we try to post photos that would not be considered objectionable. We will remove any photo immediately upon request.