Byron Community Church

The Blast 2020

• Child Name*
  First Name

  Last Name
• Grade
  >4th5th6th
• Parent/Guardian Email
   
• Emergency Contact Information
• Emergency Contact*
  First Name

  Last Name
• Contact's Relationship to Child*
• Emergency Contact Phone Number*
   

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• IMPORTANT - Please Read
• Does the child have any severe or life threatening allergies? Is there anything our volunteers should know such as any physical, emotional, or behavioral limitations in participating in the program?
• Precautions are taken for the safety and health of your child, but in the event of accident or sickness, Byron Community Church Inc, its staff, and its volunteers are hereby released from any liability. In the event that your child requires emergency treatment, you or your designated emergency contact will be notified immediately.
• In case of surgical emergency, I hereby give permission to the physician selected by Byron Community Church Inc. to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery for my child as named above. *
  I agree.
• The above named child is covered by Ontario health insurance (OHIP) or equivalent medical insurance.*
  I agree.
• Do not bring valuables to the program. Byron Community Church and all its partners are not responsible for lost or damaged property.*
  I agree.
• Please note that e-mail is the primary mode of communication. By sharing your e-mail address you will receive important information as it relates to the program.
• I hereby give Byron Community Church and all its partners, the absolute right and permission to publish/copyright/use pictures and/or video and/or audio in which I or my child may appear in whole or in part, composite or retouched in character or form.
  I agree.