We want to ensure your comfort and your child's safety as they attend Reach Youth. Fill out this registration form for your child/children so we can ensure that everyone has the best experience possible.

If you have planned a visit, you can register your child/children before you arrive.

By signing this form, I allow Light of Life Church House of Blessings to obtain records of my child/children:

1. my child/children name
2. a description of my child/children, including but not limited to their community involvement, etc.
3. a photograph of my child/children
4. a videotape, an electronic or other image of my child/children
5. a recording of my child/children voice
6. a quotation or summary of my child/children opinion that they expressed orally
7. quotation or summary of my child/children opinion that my child/children expressed in writing, including in an electronic medium

For the uses described below, and for no other purpose:

1. advertising on television, radio, newspaper or other medium
2. training video & communications materials that may be released to the media
3. Web, Internet, Intranet based communications materials
4. participation in an event where representatives of the media (television, radio, newspaper, etc.) may be present. I acknowledge that my image, name, voice, etc. may be used by the media
5. mini-documentaries in the online services of Light of Life Church House of Blessing

Personal information collected pursuant to this form is collected in compliance with section 38(2) of the Freedom of Information and Protection of Privacy Act.

The information will be used for purposes described on this form and for no other purpose. If you have any questions about the collection, use or disclosure of this personal information, contact: info@lightoflifechurch.ca

By signing this form as indicated below, you also understand that the Youth Criminal Justice Act contains provisions which protect the privacy of young offenders, alleged young offenders, young persons who are victims of such offences, as well as young persons who may be witnesses to such offences. Under the Youth Criminal Justice Act, it is an offence to disclose the identity of these individuals, as well as information relating to the offences or alleged offences in which they are involved.

• Signing this form does not, in any way, permit the disclosure of such information.
• I acknowledge that the personal information referred to above was provided freely and voluntarily.
• By signing this form, I agree to release Light of Life Church House of Blessings and its employees from any claim or liability that may arise out of the use or disclosure of the information collected on this form.