Breslau Evangelical Missionary Church

A Member of the Evangelical Missionary Church of Canada

Kid's Club Registration Form 2018 - 2019

Waiver: By filling out this form, I/we, the parents or guardians named on this form, authorize the ministry and staff of Breslau Evangelical Missionary Church to sign consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment, or procedures for the participant(s) named in this form.
I/we undertake and agree to indemnify and hold blameless the ministry staff, BEMC and its pastors and Board from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of BEMC, as well as of any medical treatment authorized by the supervising individuals representing the church. This consent and authorization is effective only when participating in or traveling to events of BEMC.
  • First Name
    Last Name
  •  
  •  
  • First Name
    Last Name
  •  
  • First Name
    Last Name
  • /
    /
  • First Name
    Last Name
  • /
    /
  • First Name
    Last Name
  • /
    /
  • First Name
    Last Name
  • /
    /