Uprising Registration (2024/2025) • International Worship Centre

REGISTRATION FORM

This is the Registration and Consent Form for the 2024/2025 Uprising school year (August 2024-July 2025).

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

In the case of custody agreements, please provide us with the proper form(s) authorizing Parental Contacts at uprising@iwcentre.com.

Parent/Guardian Information

Parent/Guardian Full Name *

Parent/Guardian Email *

Parent/Guardian Phone Number *

____________________________________________________________

Student Information

First Name *

Preferred Name

Middle Name

Last Name *

Student Phone Number

Student Email Address

Date of Birth *

Gender

School Grade *

Address

Home Address *

Home Address Line 2

City *

Country *

Province *

Postal Code *

Emergency Contact Information

Emergency Contact Full Name *

Phone Number *

Relationship to Student *

Medical Information

Family Doctor Name

PHIN (Personal Health Information Number) *

Tip: 9-Digit Number

Doctor Phone Number

Please list all allergies this student has, if any.

Does this student have any physical, emotional, mental, behavioural concerns, conditions, or limitations that staff should be aware of? *

Yes

Please explain below. *

Is this student bringing any medication with them? *

Yes

Please list and provide any instructions below. *

____________________________________________________________

Communication

A policy is in effect that communication to students outside of regular programming is to be used solely for the dissemination of information.

Press "I consent" below to grant permission for a Youth Ministry Volunteer or Staff to communicate with your Child(ren) via telephone, email, social media, and text? *

I consent.

I do not consent.

Media Release

Photos & Videos are regularly taken and used by Uprising and IWC for ministry and promotional purposes.

Press "I consent" below to grant permission for the reasonable use of pictures and videos containing your child(ren) in promotional material, in-house graphics, social media posts, and on the website. *

I consent.

I do not consent.

____________________________________________________________

Consent

The safety of your Child is our primary concern. Precautions will be taken for their well-being and protection.

I, the parent or legal guardian authorize the Ministry Leader or one of International Worship Centre Inc.'s Ministry Volunteer(s) to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the student(s) named above.

I undertake and agree to indemnify and hold harmless Ministry Volunteer(s), International Worship Centre Inc., and its Leaders from and against any loss, damage or injury suffered by the participant(s) as a result of being part of the activities of International Worship Centre Inc., as well as of any medical treatment authorized by the supervising individuals representing International Worship Centre Inc. . This consent and authorization is effective only when participating in or travelling to events sponsored by International Worship Centre Inc.

By clicking "I accept" below, you are indicating that you have read, understood, and agree with the above.

Purposes and Extent

International Worship Centre Inc. is collecting and retaining this personal information for the purpose of enrolling your child(ren) in our programs, to assign the student to the appropriate classes, to develop and nurture ongoing relationships with you and your child(ren), and to inform you of program updates and upcoming opportunities at our International Worship Centre Inc. . This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish International Worship Centre Inc. to limit the information collected, or to view your child(ren)'s information, please contact us.

Do you accept the terms and conditions stated above. *

I accept.

I do not accept.