Children's Ministry

Children's Ministry Hands Resized.jpg

KIDS CLUB 2018 REGISTRATION

 

Name of Parent/Guardian *
First Name
Middle
Last Name
Address *
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Phone*
In case of emergency, please contact: (Please include name and phone number) *
Name of First Child *
First Name
Middle
Last Name
Age*
Grade*
Gender *
Please list any allergies or medical concerns:
Name of 2nd Child
First Name
Middle
Last Name
Age of Second Child
Grade of 2nd Child
Gender
Please list any allergies or medical concerns:
Name of 3rd Child
First Name
Middle
Last Name
Age of 3rd Child
Grade of 3rd Child
Gender
Please list any allergies or medical concerns:
Name of 4th Child
First Name
Middle
Last Name
Age of 4th Child
Grade of 4th Child
Gender
Please list any allergies or medical concerns:
Medical Consent: In the event of an emergency, when the parent/guardian cannot be reached, I authorize the staff at Kids Club to exercise their best judgment in the care of my child.*
Photo Release: I hereby grant permission for photo/video images to be taken of my child/children and used in Locust Grove Mennonite Church publicity materials, including but not limited to website, brochures, newsletters and public presentations. *