King's Kids Registration

Parent Information

Parent Name

This address will receive a confirmation email

Address

Parent Cell Phone

Emergency Contact

Emergency Contact Name

Emergency Phone

Others who are authorized to drop off/ pick up your children

Child #1

Child 1 Name

Gender

Boy Girl

Date of Birth

Age

Grade

Allergies / Health Concerns / Special Notes

If 3yr-5yrs are they potty trained? Yes No

Child #2

Child 2 Name

Gender Boy Girl

Date of Birth

Age

Grade

Allergies / Health Concerns / Special Notes

If 3yr-5yrs are they potty trained? Yes No

Child #3

Child 3 Name

Gender Boy Girl

Age

Date of Birth

Grade

Allergies / Health Concerns / Special Notes

If 3yr-5yrs are they potty trained? Yes No

Child #4

Child 4 Name

Gender Boy Girl

Age

Date of Birth

Grade

Allergies / Health Concerns / Special Notes

If 3yr-5yrs are they potty trained? Yes No

Child #5

Child 5 Name

Gender Boy Girl

Age

Date of Birth

Grade

Allergies / Health Concerns / Special Notes

If 3yr-5yrs are they potty trained? Yes No

Medical and Photo Release

In the event of an emergency in which my child is in need of immediate hospitalization, medical attention or surgery, and after reasonable efforts have been made to contact me or my spouse and we cannot be located for the purpose of consenting thereto, consent for the emergency attention may be given to any person standing in loco parentis to my child. I understand that any expenses incurred in necessary emergency or other medical treatment will be borne solely by the child’s medical coverage and/or family. For severe allergies and medical conditions, please provide a separate sheet of paper with special instructions to NewDay leadership. I also give permission for NewDay Church to use photos/videos of my child in promotions.

I agree I do not agree

I would like to volunteer Yes No

Comments:

King's Kids Registration

Description

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