Application for Employment s51

112 Collier Street, Barrie, Ontario L4M 1H3 Phone 705-726-1511 Fax 705-726-0774 Email – [email protected] or [email protected]

COLLIER’S KIDS VISITOR REGISTRATION FORM- 2017 FAMILY INFORMATION

Name of Parent/Guardian ______Relationship ______first name last name

Telephone (Home) ______Office ______

Email (Home)______(Office) ______

Name of Person Attending Church:______( if different from Parent) Relationship Phone:

Emergency Contact ______Name Address

______Phone Number Relationship

1. Child’s Name: ______2. Child’s Name: ______First First ______Last (if different from above) Last (if different from above)

Birth Date:______School Grade: _____ Birth Date:______School Grade: _____ dd/mm/yy dd/mm/yy

Allergies/Medical Conditions______Allergies/Medical Conditions______

______

PHOTO/VIDEO RELEASE

I,______,PARENT/GUARDIAN the undersigned parent/guardian AUTHORIZATION of the child/children named in this form, grant permission for said child/children, to be photographed or videotaped while participating in all activities PHOTO/VIDEO RELEASE of the Children & Youth program of Collier Kids of Collier Street United Church. I also grant permission for photos I,______,or videos to be used for church purposes. the undersigned parent/guardian of the child/children named in this form,______grant permission for said child/children, to be photographed ______or videotaped while participating in all activities Parent/Guardianof the Sunday Programs Signature for Children & Youth. I also grant permission for photosDate or videos to be used for church purposes. ______Witness (Name &1 Signature) CSUC-VisitorRegistrationForm-August Date 2017 ______Parent’s Signature Date PARENT’S/GUARDIAN’S HELP

Please tick as many as may apply to YOU!

As a parent/guardian, I would love to help as a: Sunday Story Teller ____ Sunday Door Keeper ______

Sunday Helper ____ Sunday Volunteer _____

As a parent/guardian, I would love to help with: Purchasing of supplies for weekly or special occasions____

Collier’s Kids during the Week___ Youth Program _____ Clean up during the Week____

Extra pair of hands when needed____ Share a special talent on occasion______(name talent) Telephoning____ Driving____

As a parent/guardian, I suggest, the following to improve Collier’s Kids program.

______

Thank YOU!

OFFICE USE ONLY

APPLICATION RECEIVED: ______(NAME) (DATE)

APPLICATION INFORMATION PLACED IN DATABASE: ______ZONE #______

COLLIER’S KIDS ASSIGNED:

*GROUP NAME TAG WELCOME MAILING

2 CSUC-VisitorRegistrationForm-August 2017