Jr. Youth Registration and General Permission - 2025/26

For Parent/Guardian to fill out.

Your name *

Email address *

Parent Information

Parent Name(s) *

Phone number *

Student Information

Student Name *

Birthdate *

Gender *

Grade *

6-Digit MB Health Number *

9-Digit MB Health Number *

Medical Notes

School *

Volunteer Opportunities

Snack *

In Junior Youth, we love to provide a snack every week. We love that it brings a time of community and fellowship after our message. With a group our size, we need a lot of food, so we would love to give you the opportunity to help out in one of the following ways

Snack Delivery *

We are looking for people to help deliver the snack within the church on regular youth nights. You would help prepare the snack in the kitchen and deliver it to the students when they are in their groups after the message.

Helpers *

We are in need of people to help supervise games, help with small groups and special events. This is a weekly commitment.

Name of Parent Volunteer

General Permission

PARENTS PLEASE NOTE: In an attempt to simplify and minimize forms and paperwork for you the parents, we will not be sending home a permission form for each and every event. Permission for all local events is included when you sign this form. If you have any concerns or want to specify exactly which events you are giving consent for your child to participate in, please contact Gloria at gloria@gmchurch.ca or 204-362-4510. Thank you!

PHOTO / AUDIO / WEB RELEASE

I/We the undersigned consent to the use of any video, photographs, audio recordings that may be taken of the participant during their participation in any activity, event or trip to be used distributed, or shown as Gospel Mission Church and any of its representatives sees fit including but not exclusive to: slide shows, church website, print media, or social media (i.e. Facebook, Instagram).

RELEASE OF LIABILITY

I/We, the undersigned, do hereby release, forever discharge and agree to hold harmless Gospel Mission Church, its pastors, directors, employees, elders, volunteers, and representatives (collectively herein the “Church”) from any and all liability, claims or demands by myself (the undersigned), my estate, heirs, successors, assigns or other persons for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever that may occur to myself (the undersigned) or my child as a result of his/her participation in the youth events and activities of Gospel Mission Church or any events and activities of its pastors, directors, employees, elders, volunteers, and representatives. I am aware that some events, although they are organized by Gospel Mission Church, may include leaving the church grounds by way of walking, or by way of a vehicle provided by Gospel Mission Church or one of its volunteers.

I/We understand that some of these events will include (but are not limited to): The “kick-off party” at Winkler Bible Camp, small group nights, the “Wind-up party”, trips to local parks and some summer events.

PERMISSION FOR TREATMENT

In the event that I/We the undersigned parent(s) or guardian(s) cannot be reached, I/We do hereby authorize pastors, directors, employees, elders, volunteers, and representatives of Gospel Mission Church, Winkler as agent(s) for the diagnosis or treatment and hospital care which is deemed advisable by and is rendered under the general or special supervision of any physician, surgeon, anesthesiologist, dentist, or other qualified medical personnel licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital or emergency care facility. I/We the undersigned shall be liable and agree to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child or youth pursuant to this authorization.

Do you have questions or disagreements as it pertains to the general agreement above?

Parent Signature *

By typing your name below, you the parent/guardian are signing and agreeing to the above statement or if not have specified my questions/disagreements above.

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