Kidzone Child Watch Registration Form

Kidzone Child Watch Registration Form

C.K. Ray Recreation Center
Parents and Guardians,

Please complete a form for each child. Forms are updated each year. A photo of the child is necessary for the child's account.

A valid membership is required and you must purchase your punch pass at the front desk.

The Kidzone is only available to monthly members.
Full name of child*

First NameMiddle NameLast Name
Date of birth*

MonthDayYear
Date
What is your child's age today?*
BoyGirl
Parent or Guardian Name #1*

First NameMiddle NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent or Guardian Name #2

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
MotherFatherGrandparentAunt/UncleCaregiverOther
Person to call in case of emergency of someone not listed above*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Please take a new photo to submit for your child's account. You may upload more than one. Use the tips below to take a foward facing. *

Cancelof
Use the tips below:
- Use good lighting (natural or bright indoor).
- Choose a plain, light-colored background.
- Frame face and shoulders, not full body.
- Position the child straight, facing the camera.
- Keep the camera at eye level.
- No other individuals in the photo
Does your child have any known allergies, or take any regular medications?*
Write NA if not applicable
When your child is upset, what helps to comfort him/her?*
YesNo
Kidzone Guidelines
Kidzone Behavior Policy
Kidzone Sick Policy
I, the undersigned do hereby agree to display the appropriate behavior and abide by all rules and regulations while participating in the Conroe Parks and Recreation Department programs and/or activities. I understand that failure to do so may result in consequences leading up to and including dismissal from said program or facility usage. I also certify that to the best of my knowledge, I am physically fit and able to participate in said programs or activities. I agree to indemnify and hold the City of Conroe and its employees, instructors, and/or said volunteers harmless from liability, loss, cost or expenses (including attorney fees, medical, and ambulance costs) that may incur while participating in Parks and Recreation activities. In case of an emergency, I give permission for medical treatment. I also give permission for the City of Conroe to photograph me for future use in future publicity without compensation. These statements are also valid for any minors that I allow to participate. This form shall be considered valid until canceled or changed in writing by the undersigned.
Signature of parent*

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