EVENTS

Please contact the church at info@centreofhopevictory.com or call 519-395-5510 for upcoming events.

Youth Beach Mission: June 7, 2026

Chaperones: Lisa King + volunteers

First name

Last name

Address

Phone

Does your child have any life threatening allergies? (bee stings, food, penicillin, other drugs)

Yes

If yes, please explain:

Is your child bringing medication with him or her? (antibiotics, ventilator, etc.)

Yes

If yes, please explain:

Does your child have any physical, emotional, mental or behavioural concerns or limitations that our volunteers should be aware of?

Yes

If yes, please explain:

Your child must be covered by Provincial Health Insurance or equivalent medical insurance.

Name of Family Physician:

Physician's Phone Number:

MEDICAL RELEASE

Precautions are taken for the safety and health of my/our child, but in the event of accident or sickness, COH, its staff, and its volunteers are hereby released from any liability. In the event that my/our child requires special medication, x-rays or treatment, I/we understand that efforts will be made to notify me/us immediately. In case of an emergency and I/we cannot be reached I/we release the adult in authority to take the above Youth/child to the nearest available hospital.

PHOTO RELEASE

I grant permission for the reasonable use of pictures containing my child in any or all of the following ways: brochures/promotional material, church, website/social media, newsletters.

Emergency Contact Information

Primary emergency contact name and phone number:

Secondary emergency contact name and phone number: