Online Registration Form

Current Programs

Discord: Minecraft

Student's Name*
First Last
Student's Date Of Birth*
Address*
Street Address Address Line 2 City Province Postal Code
Student's Phone
Parent's Name*
First Last
Parent's Email*
Parent's Phone*
Emergency Contact Name*
First Last
Emergency Contact Phone*
Programs*
Please indicate from the program list above what your child may participate in.
Consent*
I voluntarily agree and consent to the participation of my/our Child(ren) in this supervised online program including webcam access. While every precaution is taken for the safety and good health, some online activities carry with them the inherent risk of data breaches beyond the risks associated with many of the online programs at Southwestern Ontario Youth for Christ. I/we understand that I am exposing my Child to inherent risks. I accept all these risks and agree that by allowing my Child to participate in those online programs and acknowledge that I will be responsible for any breach or other loss which may occur during my Child’s participation of these online programs.
Release of Liability*
I/we, named below, undertake and agree to indemnify and hold blameless Southwestern Ontario Youth for Christ, its Personnel, its leaders and Board from and against any loss, damage or breach suffered by the participant as a result of participating in the online programs of Southwestern Ontario Youth for Christ. This consent and authorization is effective only when participating in programs of Southwestern Ontario Youth for Christ I have read, understood and agree with above.
Parent Name*
First Last
Signature*
Terms and Conditions*
- I have read the Terms and Conditions