Wellspring Youth Annual Registration Form (2025/2026)

This form is to be completed annually by a parent/guardian to ensure we have the most up-to-date information. Fill out one form per child.

Your name *

Email address *

Family Contact Information

Receive monthly Wellspring Youth newsletter

Phone number *

Receive weekly text message reminders about youth nights and events from Wellspring Youth

By checking this box and submitting this form, you consent to receive transactional text messages for updates, reminders, and event information from Wellspring Youth. Reply STOP to opt out. Reply HELP for help. Standard message and data rates may apply. Message frequency may vary.

Address *

Emergency Contact *

Include name and phone number

Student Info

Child First & Last Name *

Birthdate *

Grade *

School *

Medical notes

Include allergies and medication your child is bringing including dose/schedule (all non-emergency medication will be kept with our team and administered when required). Also include any physical, emotional, mental, or behavioural concerns or limitations that you child has. If your child has a severe allergy, and carries an epi-pen please include that information.

Youth Contact Permission

Youth aged 12 or younger will only be contacted through their parent/guardian.

Youth aged 13 or older may be contacted via text, email or social media for the purpose of promoting church activities or to arrange face-to-face meeting only if parent/guardian consent is given. Any online communication between a youth leader and youth will be copied to the youth director and will be done within daytime hours (8am-10pm).

My youth is 12 years or younger

My youth is 13 years or older

Media Waiver *

I/we, hereby grant permission to Wellspring Church to use my child’s/children’s photograph(s) and/or video on its website or in other official internal and external church printed publications for promotional purposes without further consideration. Publications may include promotional videos, video announcements, social media, website, and other official church printed publications. Students and leaders may be photographed or videotaped by church staff or volunteers as part of our program. I understand these photograph(s) and video(s) may be used within the church. Therefore, I agree to indemnify and hold harmless the church, its members, pastors/staff, volunteers, and Board of Elders from any claims arising out of the use of my child’s/children’s photograph(s) and video.

Release of Liability

I/we, named above, undertake and agree to indemnify and hold blameless Kaeden Smith, the Ministry Staff, Wellspring Church, its Pastors and Board of Elders from and against any loss, damage or injury suffered by the participant(s) as a result of being part of the activities of Wellspring 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 and sign it to cover and give permission for my youth to attend all advertised Wellspring Youth Ministry events *

This consent and authorization is effective only when participating in or traveling to and from events of Wellspring Church. [Excluding overnight events and events outside of Hamilton/Halton Regions for which additional permission forms are required]

SIGNATURE. Type name below to sign release. *

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