The Deanery of Carleton
Registration for Ash Wednesday Activity Day
Wednesday, February 22, 2012
at Christ Church Bells Corners
3861 Richmond Road, Nepean. 613-829-1826
Drop Off: 8:00 - 8:30am - Pageant and Worship 4pm
If you are unable to join us for worship, pick up is at 4:45pm.
For: Children up to Grade 12 (all preschool children to be accompanied by an adult caregiver)
Registration forms due by: Wednesday, February 15th, 2012
Transportation Waiver:
The field trip permission form for Elementary and Middle School children will be emailed
to families after their registration has been received.
Child #1
Child's name:
Age:
Child's school:
Grade:
Allergies | health concerns:
Child #2
Child's name:
Age:
Child's school:
Grade:
Allergies | health concerns:
Child #3
Child's name:
Age:
Child's school:
Grade:
Allergies | health concerns:
CONTACT:
Parent / Guardian:
Home parish:
ON DAY OF THE EVENT:
Home Phone:
Cell
Work phone:
E-mail:
VOLUNTEER:
Volunteer's Name:
Volunteer's Phone:
Volunteer's Email:
I will be accompanying a preschooler:
Yes No
Please choose one:
I am available to volunteer for the whole day (8:00 am to 4:00 pm)
I am available to volunteer for half a day (8:00 am to 12:00 pm)
I am available to volunteer for the whole day (12:00 pm to 4:00 pm)
WAIVER:
In return for permission to attend the above Event, the undersigned acknowledges and warrants to the Church that he or she is:
Is an adult with decision-making authority for the above Participant(S), who is less than eighteen years of age, who (check one):
(a) requires no special arrangements to safely participate in the Event under normal adult Supervision, or
requires the special arrangements stated below:
Health concerns:
Medication to be provided:
(Given, with full written instructions to the in-house first aider upon arrival)
(b) gives permission for the Participant to attend the Event and delegates full decision-making authority for the Participant to the
Church while the Participant is participating in the Event.
(c) I give permission for use of my child's/children's photograph(s) in parish publications and/or the Diocesan
Newspaper, Crosstalk. I give permission:
Yes
No
Using his or her name: Yes
No
On our church website (no name): Yes
No
BY SUBMITTING THIS ONLINE FORM you are indicating to the registrar at Christ Church Bells Corners that you are an adult
with decision-making authority and have understood this registration form's intention and are hereby confirming the information in
each field and electronically signing your agreement and
permission. Note: This will be kept by the registrar as your parental permission, the same as a signed paper document.
Please enter your name:
Phone:
All information is kept for church school use only
For questions please contact Susan Whitton 613-829-1826 ex. 16
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