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.*
MEDICAL SECTION DIGITAL SIGNATURE *

By checking the I agree box below, I confirm that all the information listed on the medical section of this form is truthful and accurate. I understand that the children's ministry is concerned about the health and safety of my child and will follow the guidelines of this form in concerns to my child. I understand that neither the Faith Family Kidz Connection/Faith Kids, nor does Faith Family Church accept any responsibility in the event that my child gets hurt or sick.*
MEDICAL RELEASE*

By checking the I agree box below, I hereby release Faith Family Kidz Connection/Faith Kids, as well as Faith Family Church from responsibility and liability for any illness or injury that my child may sustain during activities held during any and all children/church functions. In the event of an emergency, I hereby authorize an adult leader of Faith Family Kidz Connection/Faith Kids, as well as Faith Family Church, to act as agent for me, to consent to any x-ray examination, medical, dental, or surgical diagnosis, treatment, and hospital care advised and supervised by a physician, surgeon, dentist (as appropriate), licensed to practice under the laws of the state where services are rendered, either at a doctor's office or in any hospital. I expect to be contacted as soon as possible.
*
PERMISSION TO PARTICIPATE

By checking the I agree box below, I give permission for my child to join the Faith Family Kidz Connection/Faith Kids, ministries of Faith Family Church, Frankfort, IN, in any of the physical or off-campus activities or trips sponsored by the ministry, the church, its staff and sponsors. If for some reason you do not wish for your child to participate in activities, then please check the box for "I don't agree" and provide information to staff directly.
*
 I AGREE
 I DON'T AGREE AND DO NOT WISH FOR MY CHILD TO PARTICIPATE IN PHYSICAL OR OFF-CAMPUS ACTIVITIES
SOCIAL MEDIA WAIVER*

By checking the I agree box below, I understand that my child may be photographed or recorded on video during the course of children's ministry events, and their image may be used in social media sites administered by Faith Family Church, as well as in print, electronic, or video form for the promotional purpose of children's ministry activities. By checking the I agree box below, I understand if I do not wish for my child's image to be reflected on any social media or promotional purposes, then it is my responsibility to inform the staff of my wishes.
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
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