Child's Name (required)
Street Address (required)
Postal Code (required)
Birth Date (required)
School Grade (required)
Care Card Number (required)
Parent's Name (required)
Parent's E-mail (required)
Phone Number (required)
What is the best way to contact your child? (required)
Child's Facebook Username
Name of first friend you would like in your group
Name of second friend you would like in your group
NOTE: We cannot guarantee that your child will be in the same group as their friends.
My child will be attending (required)
Full-time (75% or more)Part-time (less than 75%)
I hereby release the counselor(s) from all liability not covered by their insurance on my child(ren), in case of accident or injury during meetings and group activities. This consent form authorizes designated youth leaders of Langley Canadian Reformed Church to transport my child(ren) to and from activities involved with the specified program and to take any action deemed necessary for the well-being of my child(ren). Langley Canadian Reformed Church will ensure that your child(ren) will be transported by a volunteer who holds a valid BC Driver’s License.
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21804 52 Avenue, Langley, BC Phone: (604) 530 7612
Sunday @ 9:30 AM & 2:00 PM
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