Student Ministry Form | Peterborough Free Methodist Church
Caring, Praying, Responding
Peterborough Free Methodist Church
Student Ministry Form

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Children & Youth Ministries Registration Form

Peterborough Free Methodist Church – 2018-2019

Please fill out the online form below; please indicate N/A in areas that do not apply.  OR download this document fill it out and bring it to the church. 

(One form per student to be completed for anyone under the age of 18)

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

Biographical Data
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Please select one of the following:
Family Data
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Emergency Contact Information
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Ministry Area
Student Will Be Attending (Please check all that apply)*
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Secondary Address of Student (If Student resides at least partially with another parent or guardian)
Medical Information
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Medical Condition/Special Needs*
Photos/Videos
Occasionally pictures and video are taken to capture memories of certain events and to share with the rest of the congregation. Pictures and videos may be used for the purpose of promotional material on the church website and Facebook page. Please indicate your 'permission for use' by selecting an option below.*
Custody Orders or Issues
Consent for Riding the Church Van/Church Bus
The church van will be driven by a designated driver of the Peterborough Free Methodist Church. The church bus is rented from Elwood Hamilton Bus Lines and driven by a designated driver. While every precaution is taken for safety and good health, some activities including transportation carry with them the inherent risk of personal injury. Your permission is required to provide this transportation. Please carefully read the following information and consent form. If you are in agreement, please select the "Agree" option. I give permission for my child to be transported in the church van/bus and driven by authorized church personnel to and from their pick up spot and the Church. I understand that my child is expected to follow all applicable laws regarding riding in a motor vehicle and is expected to follow the directions provided by the driver and/or other adult volunteers. I have read, understand, and discussed with my child that: (1) They will be traveling in a motor vehicle driven by an adult and accompanied by a second adult and they are to wear their safety-belt while traveling; (2) They are expected to respect each other, the vehicles they ride in, and the people they travel with; (3) Riding in a motor vehicle may result in personal injuries or death from wrecks, collisions or acts by riders, other drivers, or objects; (4) They are to remain in their seats and not be disruptive to the driver of the vehicle. I recognize that by participating in this activity, as with any activity involving motor vehicle transportation, my child may risk personal injury or permanent loss. I hereby attest and verify that I have been advised of the potential risks, that I have full knowledge of the risks involved in this activity, and that I assume any expenses that may be incurred in the event of an accident, illness, or other incapacity, regardless of whether I have authorized such expenses. I hereby consent to the participation of my child in this supervised activity. I, named below, undertake and agree to indemnify and hold blameless Peterborough Free Methodist Church, its personnel, its Directors and Board from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of the Peterborough Free Methodist Church, as well as of any medical treatment authorized by the supervising individuals representing the church. I have read, understood and agree with the above.*
I/we, the parents or guardians named above, authorize Holly Raymond or her designate to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above in the event of an emergency. While every precaution will be taken to ensure the safety and protection of your child, Peterborough Free Methodist Church, its pastors, representatives and Board of Elders are hereby released from any and all liability in the event of loss, damage, or injury suffered by the participant as a result of being part of the activities of the Peterborough Free Methodist Church. *
Please Note our Code of Conduct & Attire Policy Students participating in any ministry of the Peterborough Free Methodist Church are expected to respect the property, the leaders, and other students. Any behaviour deemed inappropriate by the volunteer staff may result in the student being asked to sit out of an activity. Continuation of inappropriate behaviour may result in students being asked not to return to the program for a week until they can demonstrate appropriate behaviour. Dress Code: We ask that students refrain from wearing spaghetti strap or strapless tops, short shorts, and clothing with inappropriate slogans or graphics. If these guidelines fail to be met, students will be asked to change for the duration of the event.
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Validation Code