Sunday Programming Registration
For Sunday morning during the service/electives
Parents/Caregiver/Grandparents Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact
*
First Name
Last Name
Relationship to child
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Child #1
*
First Name
Last Name
Child #1 Birthday
*
-
Month
-
Day
Year
Date
Gender
*
Please Select
Female
Male
Grade or Years
*
Please Select
1/2yrs
3yrs
4yrs
Kindergarten
Gr1
Gr2
Gr3
Gr4
Gr5
Medical #
*
Allergies, medical concerns, behavioural concerns that affect your child and/or the children around them:
*
if none type NA
Child #2
First Name
Last Name
Child #2 Birthday
-
Month
-
Day
Year
Date
Gender
Please Select
Female
Male
Grade or Years
Please Select
1/2yrs
3yrs
4yrs
Kindergarten
Gr1
Gr2
Gr3
Gr4
Gr5
Medical #
Allergies, medical concerns, behavioural concerns that affect your child and/or the children around them:
if none type NA
Child #3
First Name
Last Name
Child #3 Birthday
-
Month
-
Day
Year
Date
Gender
Please Select
Female
Male
Grade or Years
Please Select
1/2yrs
3yrs
4yrs
Kindergarten
Gr1
Gr2
Gr3
Gr4
Gr5
Medical #
Allergies, medical concerns, behavioural concerns that affect your child and/or the children around them:
if none type NA
- I hereby authorize North Kildonan Mennonite Brethren Church (NKMB) to provide supervision and care for all children registered above. - My children will follow all regulations as set out by Manitoba Public Health - I consent to use of photographs and video of my child by NKMB - I understand that reasonable safety precautions will be taken - I understand that medical treatment will be administered in case of emergency and that all efforts will be made to contact me - I understand that my child has voluntarily chosen to participate in all activities including but not limited to, singing, bible stories, indoor and outdoor sports activities (including bouncers), crafts and snacks - I understand that my child will be asked to discontinue participating should he/she disregard expected behaviour guidelines, any and all necessary transportation arrangements will be my responsibility.
*
Please Select
Agree
Todays Date
*
-
Month
-
Day
Year
Date
Additional Comments
Submit
Should be Empty: