kidz connection registration

Child's Name:*
Grade:*
Please tell us the church you attend:
Please list allergies or any other information pertinent to your child you feel would be helpful:
Parent/Responsible Party Name:*
Cell/Phone # (best way to contact you):*
Your Address: (street, city, state, zip code)
In Case of Emergency (when parent/responsible party cannot be reached): Name, Relationship, Phone #*
Pickup authorization: (other than parent)
PERMISSION FOR ATTENDANCE & MEDICAL TREATMENT RELEASE.

I understand my child must be picked up at 7:00pm.

My permission is granted for the coordinator, church official or any adult present or in charge of First Aid, to obtain necessary medical attention in case of sickness or injury to my child. I also grant permission for my child to participate in any function related to Kidz Connection held at Faith Family Church. I agree this permission form is to be in effect from September 9, 2018 through May 31, 2019.*
Please enter your email address to receive a receipt upon submission of registration.
Parent/Responsible Party Signature. Please type in your legal name as a digital signature.*
Please select today's date.*


Submit
UA-59546613-1