• Registration Information

  • Before we begin, please confirm the below information.*

  • Due to budget constraints, our holiday gift distribution is strictly limited to CHD children and siblings under 18 years of age (17 and under). While adult siblings are always welcome to join us for cookies and festive fun with Santa, we are unfortunately no longer financially able to provide holiday gifts or gift cards for attendees aged 18 and older. Thank you so much for your understanding as we focus our non-profit resources on our growing event!

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  • CHD Child Registration:

  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Does this participant have any food allergies or dietary restrictions?*

  • Gift Selection:

    Please select at least one item in the appropriate age category for the child. Please feel free to use the "other" field if needed.
  • Birth to 24 Months
  • 2 to 4 Years
  • 5 to 7 Years
  • 8 to 13 Years
  • 14 Years & Up
  • Add a child?

  • Child 2 Registration

  • Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • Does this participant have any food allergies or dietary restrictions?*

  • Gift Selection:

    Please select at least one item in the appropriate age category for the child. Please feel free to use the "other" field if needed.
  • Birth to 24 Months
  • 2 to 4 Years
  • 5 to 7 Years
  • 8 to 13 Years
  • 14 Years & Up
  • Add a child?

  • Child 3 Registration

  • Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • Does this participant have any food allergies or dietary restrictions?*

  • Gift Selection:

    Please select at least one item in the appropriate age category for the child. Please feel free to use the "other" field if needed.
  • Birth to 24 Months
  • 2 to 4 Years
  • 5 to 7 Years
  • 8 to 13 Years
  • 14 Years & Up
  • Add a child?

  • Child 4 Registration

  • Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • Does this participant have any food allergies or dietary restrictions?*

  • Gift Selection:

    Please select at least one item in the appropriate age category for the child. Please feel free to use the "other" field if needed.
  • Birth to 24 Months
  • 2 to 4 Years
  • 5 to 7 Years
  • 8 to 13 Years
  • 14 Years & Up
  • Add a child?

  • Child 5 Registration

  • Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • Does this participant have any food allergies or dietary restrictions?*

  • Gift Selection:

    Please select at least one item in the appropriate age category for the child. Please feel free to use the "other" field if needed.
  • Birth to 24 Months
  • 2 to 4 Years
  • 5 to 7 Years
  • 8 to 13 Years
  • 14 Years & Up
  • Add a child?

  • Child 6 Registration

  • Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • Does this participant have any food allergies or dietary restrictions?*

  • Gift Selection:

    Please select at least one item in the appropriate age category for the child. Please feel free to use the "other" field if needed.
  • Birth to 24 Months
  • 2 to 4 Years
  • 5 to 7 Years
  • 8 to 13 Years
  • 14 Years & Up
  • Add a child?

  • Child 7 Registration

  • Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • Does this participant have any food allergies or dietary restrictions?*

  • Gift Selection:

    Please select at least one item in the appropriate age category for the child. Please feel free to use the "other" field if needed.
  • Birth to 24 Months
  • 2 to 4 Years
  • 5 to 7 Years
  • 8 to 13 Years
  • 14 Years & Up
  • Add a child?

  • Child 8 Registration

  • Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • Does this participant have any food allergies or dietary restrictions?*

  • Gift Selection:

    Please select at least one item in the appropriate age category for the child. Please feel free to use the "other" field if needed.
  • Birth to 24 Months
  • 2 to 4 Years
  • 5 to 7 Years
  • 8 to 13 Years
  • 14 Years & Up
  • Add a child?

  • Child 9 Registration

  • Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • Does this participant have any food allergies or dietary restrictions?*

  • Gift Selection:

    Please select at least one item in the appropriate age category for the child. Please feel free to use the "other" field if needed.
  • Birth to 24 Months
  • 2 to 4 Years
  • 5 to 7 Years
  • 8 to 13 Years
  • 14 Years & Up

  •  

    Standard Photo & Video Release From (required) 

    I hereby authorize Kerrington's Heart, Inc. to publish the photographs and video's taken of me and/or the Cookies with Santa registered minor children.  I also authorize our names for use in Kerrington's Heart, Inc. printed publications, website, and social media.

    I release Kerrington's Heart, Inc. from any expectation of confidentiality for minor children and myself.  I attest that I am the parent or legal guardian of the children listed above and that I have the authority to authorize Kerrington's Heart, Inc. to use their photographs, videos, and names.

    I acknowledge that since participants in publications and websites produced by Kerrington's Heart, Inc. is voluntary, neither the minor children nor I will receive financial compensation.

    I further agree that participation in any publication and website produced by Kerrington's Heart, Inc. confers no rights of ownership whatsoever.  I release Kerrington's Heart, Inc., its board members, and volunteers from liability for any claims by me or any third parts in connection with my participation or the participation of the listed minor children.

     

    My signature is consent to these terms. 

     

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